- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.20 / $115.21 / $134.93
| Facility | | $101.20 | $115.21 | $134.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.54 / $115.00 / $155.00
| Professional | | $73.54 | $115.00 | $155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.21 / $157.87 / $256.52
| Professional | | $137.21 | $157.87 | $256.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.61 / $94.06 / $114.31
| Professional | | $71.61 | $94.06 | $114.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.10 / $140.90 / $180.56
| Facility | | $127.10 | $140.90 | $180.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.28 / $142.56 / $194.10
| Professional | | $105.28 | $142.56 | $194.10 |