- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.34 / $123.36 / $785.40
| Facility | | $77.34 | $123.36 | $785.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.35 / $124.59 / $137.06
| Professional | | $123.35 | $124.59 | $137.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.43 / $135.22 / $181.92
| Facility | | $111.43 | $135.22 | $181.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.05 / $108.05 / $108.05
| Professional | | $108.05 | $108.05 | $108.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.36 / $123.36 / $123.36
| Facility | | $123.36 | $123.36 | $123.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.36 / $123.36 / $191.91
| Professional | | $123.36 | $123.36 | $191.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.36 / $123.36 / $123.36
| Professional | | $123.36 | $123.36 | $123.36 |