- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $138.04 / $331.13
| Facility | | $95.50 | $138.04 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $70.79 / $117.49
| Professional | | $56.23 | $70.79 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $131.83 / $263.03
| Facility | | $107.15 | $131.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $87.10
| Professional | | $56.23 | $56.23 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $60.26 / $104.71
| Facility | | $38.02 | $60.26 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Professional | | $199.53 | $199.53 | $199.53 |