- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.09 / $78.06 / $174.01
| Facility | | $64.09 | $78.06 | $174.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.84 / $84.79 / $105.21
| Professional | | $69.84 | $84.79 | $105.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.34 / $108.35 / $108.35
| Facility | | $104.34 | $108.35 | $108.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.00 / $123.00 / $123.00
| Professional | | $123.00 | $123.00 | $123.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.59 / $106.82 / $146.71
| Professional | | $82.59 | $106.82 | $146.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.46 / $101.49 / $141.75
| Professional | | $93.46 | $101.49 | $141.75 |