- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.45 / $193.03 / $370.36
| Facility | | $105.45 | $193.03 | $370.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.14 / $53.78 / $57.28
| Professional | | $34.14 | $53.78 | $57.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $79.22 / $87.65
| Facility | | $75.86 | $79.22 | $87.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.31 / $48.31 / $122.61
| Professional | | $48.31 | $48.31 | $122.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.74 / $189.96 / $270.27
| Facility | | $153.74 | $189.96 | $270.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.53 / $73.93 / $92.41
| Professional | | $46.53 | $73.93 | $92.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.54 / $53.99 / $127.44
| Professional | | $22.54 | $53.99 | $127.44 |