- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.70 / $154.86 / $230.84
| Facility | | $62.70 | $154.86 | $230.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.68 / $174.36 / $194.47
| Professional | | $75.68 | $174.36 | $194.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.21 / $108.21 / $108.21
| Facility | | $108.21 | $108.21 | $108.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.21 / $108.21 / $108.21
| Professional | | $108.21 | $108.21 | $108.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.27 / $72.67 / $173.19
| Facility | | $62.27 | $72.67 | $173.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.09 / $90.36 / $213.23
| Professional | | $43.09 | $90.36 | $213.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.24 / $57.48 / $169.65
| Professional | | $40.24 | $57.48 | $169.65 |