- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.88 / $107.89 / $133.24
| Facility | | $105.88 | $107.89 | $133.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.54 / $112.64 / $158.94
| Professional | | $89.54 | $112.64 | $158.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.94 / $219.39 / $409.88
| Facility | | $204.94 | $219.39 | $409.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.41 / $111.51 / $164.32
| Professional | | $102.41 | $111.51 | $164.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.11 / $149.11 / $149.11
| Facility | | $149.11 | $149.11 | $149.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.85 / $132.87 / $153.58
| Professional | | $108.85 | $132.87 | $153.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.44 / $101.45 / $153.62
| Professional | | $77.44 | $101.45 | $153.62 |