- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.20 / $128.47 / $182.11
| Facility | | $70.20 | $128.47 | $182.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.46 / $80.73 / $142.51
| Professional | | $55.46 | $80.73 | $142.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.47 / $104.47 / $104.47
| Facility | | $104.47 | $104.47 | $104.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.47 / $104.47 / $104.47
| Professional | | $104.47 | $104.47 | $104.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.63 / $47.91 / $72.67
| Facility | | $45.63 | $47.91 | $72.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.36 / $67.20 / $126.79
| Professional | | $33.36 | $67.20 | $126.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.48 / $43.33 / $133.13
| Professional | | $29.48 | $43.33 | $133.13 |