- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.11 / $106.30 / $255.73
| Facility | | $68.11 | $106.30 | $255.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.62 / $57.36 / $98.47
| Professional | | $45.62 | $57.36 | $98.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.66 / $93.73 / $201.36
| Facility | | $54.66 | $93.73 | $201.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.17 / $53.46 / $91.18
| Professional | | $45.17 | $53.46 | $91.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.77 / $52.33 / $78.59
| Facility | | $36.77 | $52.33 | $78.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.00 / $197.00 / $197.00
| Professional | | $197.00 | $197.00 | $197.00 |