- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.06 / $73.06 / $123.34
| Facility | | $73.06 | $73.06 | $123.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.06 / $84.64 / $128.32
| Professional | | $73.06 | $84.64 | $128.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.46 / $58.15 / $65.92
| Professional | | $56.46 | $58.15 | $65.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.75 / $117.57 / $143.69
| Facility | | $85.75 | $117.57 | $143.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.09 / $113.22 / $139.34
| Professional | | $87.09 | $113.22 | $139.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.25 / $108.25 / $108.25
| Facility | | $108.25 | $108.25 | $108.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.14 / $73.14 / $385.12
| Professional | | $73.14 | $73.14 | $385.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $45.00
| Professional | | $45.00 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.30 / $95.13 / $142.69
| Professional | | $72.30 | $95.13 | $142.69 |