- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.51 / $126.51 / $139.35
| Facility | | $104.51 | $126.51 | $139.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.07 / $116.56 / $193.71
| Professional | | $92.07 | $116.56 | $193.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.08 / $114.06 / $255.75
| Professional | | $106.08 | $114.06 | $255.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.00 / $117.00 / $117.00
| Professional | | $117.00 | $117.00 | $117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.00 / $119.00 / $153.44
| Professional | | $81.00 | $119.00 | $153.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $92.47
| Professional | | $32.34 | $32.34 | $92.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.68 / $128.51 / $230.76
| Professional | | $103.68 | $128.51 | $230.76 |