- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.29 / $120.46 / $414.00
| Facility | | $106.29 | $120.46 | $414.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.37 / $106.62 / $172.00
| Professional | | $82.37 | $106.62 | $172.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.31 / $125.92 / $161.37
| Professional | | $102.31 | $125.92 | $161.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $60.00
| Facility | | $60.00 | $60.00 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.00 / $104.00 / $194.91
| Professional | | $68.00 | $104.00 | $194.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.71 / $116.25 / $163.28
| Professional | | $86.71 | $116.25 | $163.28 |