- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.16 / $109.13 / $110.30
| Facility | | $63.16 | $109.13 | $110.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.81 / $31.83 / $45.62
| Professional | | $22.81 | $31.83 | $45.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.82 / $70.70 / $79.23
| Professional | | $52.82 | $70.70 | $79.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.06 / $40.06 / $58.81
| Professional | | $40.06 | $40.06 | $58.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.05 / $26.67 / $73.68
| Facility | | $21.05 | $26.67 | $73.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $42.11 / $70.18
| Professional | | $17.89 | $42.11 | $70.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.74 / $35.79 / $59.65
| Professional | | $14.74 | $35.79 | $59.65 |