- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $346.74 / $346.74
| Facility | | $77.62 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $83.18 / $123.03
| Professional | | $74.13 | $83.18 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $346.74 / $346.74
| Facility | | $109.65 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $109.65 / $181.97
| Professional | | $93.33 | $109.65 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $52.48 / $87.10
| Facility | | $32.36 | $52.48 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $123.03 / $186.21
| Professional | | $53.70 | $123.03 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $93.33 / $147.91
| Professional | | $77.62 | $93.33 | $147.91 |