- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.88 / $118.73 / $131.71
| Facility | | $64.88 | $118.73 | $131.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.26 / $71.37 / $124.57
| Professional | | $51.26 | $71.37 | $124.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.35 / $106.35 / $106.35
| Facility | | $106.35 | $106.35 | $106.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.35 / $106.35 / $106.35
| Professional | | $106.35 | $106.35 | $106.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.17 / $67.17 / $129.91
| Facility | | $42.17 | $67.17 | $129.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.53 / $42.38 / $93.44
| Professional | | $29.53 | $42.38 | $93.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.25 / $38.93 / $123.06
| Professional | | $27.25 | $38.93 | $123.06 |