- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.53 / $62.41 / $107.26
| Facility | | $51.53 | $62.41 | $107.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.65 / $63.37 / $101.13
| Professional | | $38.65 | $63.37 | $101.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.22 / $75.88 / $93.38
| Professional | | $43.22 | $75.88 | $93.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.86 / $37.14 / $76.68
| Facility | | $36.86 | $37.14 | $76.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.45 / $78.77 / $125.68
| Professional | | $43.45 | $78.77 | $125.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.40 / $82.21 / $151.08
| Professional | | $65.40 | $82.21 | $151.08 |