- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.28 / $93.73 / $148.07
| Facility | | $45.28 | $93.73 | $148.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.28 / $48.89 / $58.58
| Professional | | $45.28 | $48.89 | $58.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.00 / $100.00 / $142.46
| Professional | | $91.00 | $100.00 | $142.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.07 / $37.07 / $70.44
| Facility | | $37.07 | $37.07 | $70.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.81 / $76.00 / $76.00
| Professional | | $49.81 | $76.00 | $76.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.45 / $48.18 / $52.96
| Professional | | $45.45 | $48.18 | $52.96 |