- 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
- $52.82 / $52.82 / $67.06
| Professional | | $52.82 | $52.82 | $67.06 |
- 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
- $60.29 / $153.74 / $270.27
| Facility | | $60.29 | $153.74 | $270.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.53 / $71.20 / $92.41
| Professional | | $46.53 | $71.20 | $92.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.54 / $45.00 / $103.06
| Professional | | $22.54 | $45.00 | $103.06 |