- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.30 / $134.13 / $321.91
| Facility | | $107.30 | $134.13 | $321.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.60 / $100.60 / $107.30
| Professional | | $100.60 | $100.60 | $107.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.18 / $87.18 / $117.69
| Facility | | $87.18 | $87.18 | $117.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.72 / $163.72 / $196.17
| Professional | | $163.72 | $163.72 | $196.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.60 / $134.13 / $225.34
| Facility | | $100.60 | $134.13 | $225.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.33 / $56.33 / $177.05
| Professional | | $56.33 | $56.33 | $177.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.33 / $56.33 / $85.84
| Professional | | $56.33 | $56.33 | $85.84 |