- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.15 / $100.67 / $118.44
| Facility | | $76.15 | $100.67 | $118.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.14 / $105.92 / $138.37
| Professional | | $77.14 | $105.92 | $138.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.00 / $152.00 / $152.00
| Professional | | $152.00 | $152.00 | $152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.01 / $136.36 / $136.36
| Professional | | $127.01 | $136.36 | $136.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.87 / $104.58 / $155.09
| Professional | | $77.87 | $104.58 | $155.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.57 / $126.49 / $167.99
| Professional | | $105.57 | $126.49 | $167.99 |