- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $128.82 / $245.47
| Facility | | $95.50 | $128.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $107.15 / $162.18
| Professional | | $91.20 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $275.42 / $309.03
| Professional | | $199.53 | $275.42 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $194.98
| Professional | | $158.49 | $158.49 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $104.71 / $245.47
| Facility | | $81.28 | $104.71 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $162.18 / $275.42
| Professional | | $57.54 | $162.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $141.25 / $234.42
| Professional | | $57.54 | $141.25 | $234.42 |