- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $60.26 / $75.86
| Facility | | $54.95 | $60.26 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $79.43 / $177.83
| Professional | | $54.95 | $79.43 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $77.62 / $109.65
| Professional | | $63.10 | $77.62 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $169.82 / $229.09
| Facility | | $141.25 | $169.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $79.43 / $100.00
| Professional | | $52.48 | $79.43 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $81.28 / $144.54
| Professional | | $60.26 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $67.61 / $102.33
| Professional | | $53.70 | $67.61 | $102.33 |