- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.40 / $431.78 / $566.09
| Facility | | $82.40 | $431.78 | $566.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.40 / $92.32 / $118.02
| Professional | | $82.40 | $92.32 | $118.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.39 / $45.39 / $45.39
| Facility | | $45.39 | $45.39 | $45.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.73 / $105.73 / $132.16
| Professional | | $105.73 | $105.73 | $132.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.20 / $103.83 / $149.72
| Facility | | $82.20 | $103.83 | $149.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.67 / $31.33 / $34.81
| Professional | | $23.67 | $31.33 | $34.81 |