- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.20 / $208.72 / $208.72
| Facility | | $52.20 | $208.72 | $208.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.65 / $66.84 / $122.13
| Professional | | $36.65 | $66.84 | $122.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.02 / $70.16 / $114.41
| Professional | | $40.02 | $70.16 | $114.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.61 / $71.03 / $125.56
| Professional | | $34.61 | $71.03 | $125.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.84 / $78.70 / $128.44
| Professional | | $46.84 | $78.70 | $128.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.61 / $62.57 / $130.51
| Professional | | $39.61 | $62.57 | $130.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.76 / $63.62 / $115.15
| Professional | | $39.76 | $63.62 | $115.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.51 / $41.37 / $71.12
| Professional | | $32.51 | $41.37 | $71.12 |