- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $63.10 / $74.13
| Facility | | $56.23 | $63.10 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $61.66 / $77.62
| Professional | | $47.86 | $61.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $63.10 / $95.50
| Professional | | $48.98 | $63.10 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $61.66 / $85.11
| Professional | | $56.23 | $61.66 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $67.61 / $114.82
| Facility | | $47.86 | $67.61 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $66.07 / $107.15
| Professional | | $5.37 | $66.07 | $107.15 |