- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.38 / $166.86 / $309.02
| Facility | | $128.38 | $166.86 | $309.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.45 / $130.03 / $289.30
| Professional | | $106.45 | $130.03 | $289.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.04
| Facility | | $0.02 | $0.03 | $0.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.42 / $286.83 / $549.37
| Professional | | $261.42 | $286.83 | $549.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.69 / $128.69 / $128.69
| Facility | | $128.69 | $128.69 | $128.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.69 / $128.69 / $128.69
| Professional | | $128.69 | $128.69 | $128.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.31 / $259.31 / $325.43
| Professional | | $259.31 | $259.31 | $325.43 |