- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.33 / $80.01 / $167.00
| Facility | | $64.33 | $80.01 | $167.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.07 / $70.76 / $87.77
| Professional | | $63.07 | $70.76 | $87.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.34 / $85.88 / $140.03
| Professional | | $71.34 | $85.88 | $140.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.67 / $102.67 / $102.67
| Professional | | $102.67 | $102.67 | $102.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.67 / $102.67 / $102.67
| Professional | | $102.67 | $102.67 | $102.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.21 / $137.75 / $203.98
| Professional | | $103.21 | $137.75 | $203.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.29 / $98.62 / $148.47
| Professional | | $67.29 | $98.62 | $148.47 |