- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.70 / $114.12 / $140.81
| Facility | | $93.70 | $114.12 | $140.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.37 / $119.69 / $140.81
| Professional | | $97.37 | $119.69 | $140.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.48 / $92.48 / $92.48
| Facility | | $92.48 | $92.48 | $92.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.82 / $129.82 / $140.38
| Professional | | $129.82 | $129.82 | $140.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.72 / $169.98 / $342.88
| Professional | | $104.72 | $169.98 | $342.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.61 / $122.51 / $158.08
| Professional | | $80.61 | $122.51 | $158.08 |