- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.00 / $91.86 / $108.07
| Facility | | $81.00 | $91.86 | $108.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.41 / $107.28 / $233.10
| Professional | | $78.41 | $107.28 | $233.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.48 / $142.72 / $234.13
| Professional | | $121.48 | $142.72 | $234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.17 / $94.06 / $113.84
| Professional | | $72.17 | $94.06 | $113.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.77 / $157.58 / $176.64
| Professional | | $110.77 | $157.58 | $176.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.28 / $126.84 / $175.16
| Professional | | $97.28 | $126.84 | $175.16 |