- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.52 / $99.89 / $244.00
| Facility | | $61.52 | $99.89 | $244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.96 / $59.81 / $63.05
| Professional | | $56.96 | $59.81 | $63.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.63 / $72.97 / $242.82
| Facility | | $52.63 | $72.97 | $242.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.11 / $84.71 / $124.94
| Professional | | $46.11 | $84.71 | $124.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.13 / $49.13 / $97.03
| Professional | | $49.13 | $49.13 | $97.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.69 / $81.88 / $122.82
| Facility | | $73.69 | $81.88 | $122.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.75 / $39.95 / $110.21
| Professional | | $32.75 | $39.95 | $110.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.18 / $34.18 / $42.41
| Professional | | $34.18 | $34.18 | $42.41 |