- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.53 / $141.56 / $587.16
| Facility | | $95.53 | $141.56 | $587.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.43 / $103.33 / $256.02
| Professional | | $90.43 | $103.33 | $256.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.73 / $118.58 / $150.60
| Professional | | $106.73 | $118.58 | $150.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.70 / $111.32 / $237.41
| Professional | | $80.70 | $111.32 | $237.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.95 / $130.31 / $185.59
| Professional | | $107.95 | $130.31 | $185.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.00 / $106.23 / $320.85
| Professional | | $73.00 | $106.23 | $320.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.66 / $120.66 / $157.97
| Professional | | $76.66 | $120.66 | $157.97 |