- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.00 / $93.50 / $110.00
| Facility | | $83.00 | $93.50 | $110.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.55 / $78.03 / $109.27
| Professional | | $58.55 | $78.03 | $109.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.00 / $77.48 / $132.13
| Professional | | $46.00 | $77.48 | $132.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.88 / $103.77 / $107.69
| Professional | | $89.88 | $103.77 | $107.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.44 / $86.78 / $205.28
| Professional | | $51.44 | $86.78 | $205.28 |