- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.65 / $118.36 / $260.64
| Facility | | $98.65 | $118.36 | $260.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.59 / $91.43 / $137.00
| Professional | | $65.59 | $91.43 | $137.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.00 / $102.00 / $144.19
| Professional | | $71.00 | $102.00 | $144.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.17 / $90.12 / $106.03
| Professional | | $72.17 | $90.12 | $106.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.45 / $112.43 / $145.27
| Professional | | $86.45 | $112.43 | $145.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.20 / $105.08 / $151.53
| Professional | | $85.20 | $105.08 | $151.53 |