- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.70 / $100.33 / $241.36
| Facility | | $70.70 | $100.33 | $241.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.82 / $34.65 / $40.01
| Professional | | $31.82 | $34.65 | $40.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.51 / $91.56 / $190.05
| Facility | | $57.51 | $91.56 | $190.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.50 / $31.50 / $31.50
| Professional | | $31.50 | $31.50 | $31.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.00 / $90.00 / $90.00
| Facility | | $90.00 | $90.00 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.35 / $105.35 / $105.35
| Professional | | $105.35 | $105.35 | $105.35 |