- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.57 / $71.43 / $83.43
| Facility | | $62.57 | $71.43 | $83.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.67 / $78.53 / $168.21
| Professional | | $56.67 | $78.53 | $168.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.40 / $100.67 / $159.65
| Professional | | $85.40 | $100.67 | $159.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.17 / $94.06 / $112.18
| Professional | | $72.17 | $94.06 | $112.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.52 / $107.20 / $119.44
| Professional | | $78.52 | $107.20 | $119.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.92 / $89.76 / $121.53
| Professional | | $65.92 | $89.76 | $121.53 |