- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.06 / $117.86 / $271.58
| Facility | | $75.06 | $117.86 | $271.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.88 / $109.33 / $187.55
| Professional | | $62.88 | $109.33 | $187.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.43 / $319.02 / $376.14
| Facility | | $169.43 | $319.02 | $376.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.98 / $103.42 / $140.74
| Professional | | $71.98 | $103.42 | $140.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.58 / $125.88 / $224.93
| Professional | | $70.58 | $125.88 | $224.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.88 / $125.47 / $187.06
| Professional | | $102.88 | $125.47 | $187.06 |