- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.36 / $125.42 / $301.70
| Facility | | $80.36 | $125.42 | $301.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.82 / $67.68 / $116.17
| Professional | | $53.82 | $67.68 | $116.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.48 / $110.58 / $237.56
| Facility | | $64.48 | $110.58 | $237.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.29 / $63.07 / $107.57
| Professional | | $53.29 | $63.07 | $107.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.21 / $59.51 / $85.14
| Facility | | $44.21 | $59.51 | $85.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.00 / $196.00 / $196.00
| Professional | | $196.00 | $196.00 | $196.00 |