- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.02 / $103.09 / $118.10
| Facility | | $93.02 | $103.09 | $118.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.53 / $108.52 / $196.60
| Professional | | $91.53 | $108.52 | $196.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.61 / $125.61 / $125.61
| Facility | | $125.61 | $125.61 | $125.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.70 / $91.70 / $187.69
| Professional | | $91.70 | $91.70 | $187.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.87 / $137.87 / $173.80
| Facility | | $137.87 | $137.87 | $173.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.55 / $163.54 / $224.52
| Professional | | $128.55 | $163.54 | $224.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.65 / $137.93 / $151.72
| Professional | | $89.65 | $137.93 | $151.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.55 / $109.67 / $143.88
| Professional | | $90.55 | $109.67 | $143.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.93 / $137.93 / $137.93
| Professional | | $137.93 | $137.93 | $137.93 |