- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.18 / $33.15 / $37.22
| Facility | | $31.18 | $33.15 | $37.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.22 / $32.65 / $39.68
| Professional | | $26.22 | $32.65 | $39.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.02 / $46.02 / $73.62
| Facility | | $46.02 | $46.02 | $73.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.04 / $46.32 / $53.40
| Professional | | $37.04 | $46.32 | $53.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.04 / $57.04 / $57.04
| Facility | | $57.04 | $57.04 | $57.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.86 / $30.86 / $30.86
| Professional | | $30.86 | $30.86 | $30.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.01 / $30.16 / $47.60
| Professional | | $23.01 | $30.16 | $47.60 |