- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.60 / $204.84 / $278.76
| Facility | | $93.60 | $204.84 | $278.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.01 / $96.83 / $157.97
| Professional | | $84.01 | $96.83 | $157.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.59 / $125.00 / $208.30
| Professional | | $96.59 | $125.00 | $208.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.99 / $140.88 / $250.20
| Professional | | $101.99 | $140.88 | $250.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.76 / $184.75 / $227.92
| Professional | | $132.76 | $184.75 | $227.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.64 / $156.72 / $255.23
| Professional | | $126.64 | $156.72 | $255.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.60 / $196.97 / $278.76
| Facility | | $93.60 | $196.97 | $278.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.10 / $96.80 / $157.58
| Professional | | $83.10 | $96.80 | $157.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.27 / $150.29 / $224.74
| Professional | | $104.27 | $150.29 | $224.74 |