- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.73 / $171.92 / $208.37
| Facility | | $75.73 | $171.92 | $208.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.23 / $58.98 / $73.30
| Professional | | $47.23 | $58.98 | $73.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.43 / $68.59 / $123.20
| Professional | | $51.43 | $68.59 | $123.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.03 / $90.12 / $158.06
| Professional | | $63.03 | $90.12 | $158.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.02 / $92.52 / $160.47
| Professional | | $53.02 | $92.52 | $160.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.13 / $105.27 / $195.26
| Professional | | $90.13 | $105.27 | $195.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.56 / $54.28 / $65.14
| Professional | | $43.56 | $54.28 | $65.14 |