- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.53 / $119.44 / $287.33
| Facility | | $76.53 | $119.44 | $287.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.26 / $64.45 / $110.64
| Professional | | $51.26 | $64.45 | $110.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.42 / $105.31 / $226.25
| Facility | | $61.42 | $105.31 | $226.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.75 / $60.07 / $102.45
| Professional | | $50.75 | $60.07 | $102.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.09 / $50.85 / $107.58
| Facility | | $34.09 | $50.85 | $107.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.00 / $246.00 / $246.00
| Professional | | $246.00 | $246.00 | $246.00 |