- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.07 / $98.26 / $115.60
| Facility | | $84.07 | $98.26 | $115.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.62 / $96.83 / $118.09
| Professional | | $81.62 | $96.83 | $118.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.10 / $125.52 / $202.01
| Professional | | $92.10 | $125.52 | $202.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.70 / $194.46 / $341.42
| Professional | | $110.70 | $194.46 | $341.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.83 / $106.54 / $215.01
| Professional | | $78.83 | $106.54 | $215.01 |