- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.63 / $164.02 / $285.26
| Facility | | $142.63 | $164.02 | $285.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.25 / $164.02 / $164.02
| Professional | | $111.25 | $164.02 | $164.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.22 / $175.03 / $235.48
| Facility | | $144.22 | $175.03 | $235.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.55 / $110.19 / $130.02
| Professional | | $92.55 | $110.19 | $130.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.86 / $115.89 / $308.72
| Facility | | $90.86 | $115.89 | $308.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.10 / $114.10 / $114.10
| Professional | | $114.10 | $114.10 | $114.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.90 / $59.90 / $142.63
| Professional | | $59.90 | $59.90 | $142.63 |