- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.76 / $153.28 / $170.03
| Facility | | $83.76 | $153.28 | $170.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.17 / $153.28 / $153.28
| Professional | | $66.17 | $153.28 | $153.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.25 / $32.25 / $32.25
| Facility | | $32.25 | $32.25 | $32.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.25 / $32.25 / $32.25
| Professional | | $32.25 | $32.25 | $32.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.44 / $54.44 / $57.16
| Facility | | $54.44 | $54.44 | $57.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.23 / $96.23 / $120.29
| Professional | | $96.23 | $96.23 | $120.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $20.00 / $20.00
| Professional | | $17.00 | $20.00 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.18 / $46.07 / $125.64
| Professional | | $35.18 | $46.07 | $125.64 |