- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.02 / $124.35 / $160.16
| Facility | | $122.02 | $124.35 | $160.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.41 / $126.85 / $182.38
| Professional | | $97.41 | $126.85 | $182.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.74 / $272.74 / $435.48
| Facility | | $217.74 | $272.74 | $435.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.08 / $132.08 / $191.06
| Professional | | $132.08 | $132.08 | $191.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.85 / $140.85 / $155.18
| Facility | | $140.85 | $140.85 | $155.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.82 / $102.82 / $252.38
| Professional | | $102.82 | $102.82 | $252.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.56 / $108.63 / $174.19
| Professional | | $96.56 | $108.63 | $174.19 |