- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.26 / $72.26 / $83.39
| Facility | | $72.26 | $72.26 | $83.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.98 / $77.94 / $90.90
| Professional | | $70.98 | $77.94 | $90.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.52 / $104.52 / $104.52
| Facility | | $104.52 | $104.52 | $104.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.82 / $105.82 / $105.82
| Facility | | $105.82 | $105.82 | $105.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.45 / $79.45 / $185.20
| Professional | | $79.45 | $79.45 | $185.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.34 / $87.36 / $269.77
| Professional | | $87.34 | $87.36 | $269.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.10 / $216.40 / $216.40
| Professional | | $176.10 | $216.40 | $216.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.05 / $114.73 / $177.95
| Professional | | $86.05 | $114.73 | $177.95 |