- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.60 / $127.08 / $371.57
| Facility | | $85.60 | $127.08 | $371.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.04 / $104.84 / $146.29
| Professional | | $70.04 | $104.84 | $146.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.86 / $346.44 / $376.14
| Facility | | $183.86 | $346.44 | $376.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.79 / $112.23 / $155.33
| Professional | | $84.79 | $112.23 | $155.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.93 / $137.72 / $245.62
| Professional | | $79.93 | $137.72 | $245.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.31 / $130.21 / $204.26
| Professional | | $113.31 | $130.21 | $204.26 |