- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.41 / $238.77 / $470.34
| Facility | | $136.41 | $238.77 | $470.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.03 / $136.40 / $153.33
| Professional | | $57.03 | $136.40 | $153.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.77 / $105.55 / $191.56
| Facility | | $55.77 | $105.55 | $191.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.85 / $70.53 / $104.73
| Professional | | $55.85 | $70.53 | $104.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.36 / $173.85 / $367.53
| Facility | | $97.36 | $173.85 | $367.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.68 / $104.25 / $157.08
| Professional | | $71.68 | $104.25 | $157.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.59 / $89.24 / $153.38
| Professional | | $47.59 | $89.24 | $153.38 |