- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.65 / $71.48 / $121.60
| Facility | | $30.65 | $71.48 | $121.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.52 / $126.20 / $347.34
| Professional | | $82.52 | $126.20 | $347.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.20 / $145.05 / $228.32
| Professional | | $103.20 | $145.05 | $228.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.37 / $122.33 / $150.06
| Professional | | $94.37 | $122.33 | $150.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.99 / $157.57 / $246.17
| Professional | | $101.99 | $157.57 | $246.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.23 / $147.06 / $216.73
| Professional | | $112.23 | $147.06 | $216.73 |