- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.09 / $100.09 / $100.09
| Facility | | $100.09 | $100.09 | $100.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.72 / $103.61 / $113.85
| Professional | | $47.72 | $103.61 | $113.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.51 / $173.65 / $184.98
| Professional | | $146.51 | $173.65 | $184.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.83 / $226.68 / $340.60
| Professional | | $152.83 | $226.68 | $340.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.23 / $100.09 / $176.78
| Facility | | $64.23 | $100.09 | $176.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.89 / $105.26 / $626.73
| Professional | | $57.89 | $105.26 | $626.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.24 / $114.91 / $208.48
| Professional | | $62.24 | $114.91 | $208.48 |