- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.65 / $143.93 / $159.66
| Facility | | $78.65 | $143.93 | $159.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.13 / $86.52 / $151.01
| Professional | | $62.13 | $86.52 | $151.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.42 / $80.42 / $80.42
| Facility | | $80.42 | $80.42 | $80.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.42 / $80.42 / $80.42
| Professional | | $80.42 | $80.42 | $80.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.22 / $56.55 / $79.12
| Facility | | $37.22 | $56.55 | $79.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.57 / $35.79 / $113.06
| Professional | | $23.57 | $35.79 | $113.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.64 / $33.03 / $117.98
| Professional | | $22.64 | $33.03 | $117.98 |