- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $77.62 / $102.33
| Facility | | $75.86 | $77.62 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $104.71 / $245.47
| Professional | | $79.43 | $104.71 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $81.28 / $112.20
| Professional | | $77.62 | $81.28 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $81.28 / $134.90
| Professional | | $60.26 | $81.28 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $123.03 / $162.18
| Professional | | $74.13 | $123.03 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $107.15 / $151.36
| Professional | | $83.18 | $107.15 | $151.36 |