- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.09 / $129.38 / $282.63
| Facility | | $100.09 | $129.38 | $282.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.09 / $101.09 / $121.36
| Professional | | $100.09 | $101.09 | $121.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.75 / $78.58 / $106.85
| Facility | | $56.75 | $78.58 | $106.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.85 / $106.85 / $108.99
| Professional | | $106.85 | $106.85 | $108.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.42 / $94.42 / $100.09
| Facility | | $94.42 | $94.42 | $100.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.09 / $100.09 / $100.09
| Professional | | $100.09 | $100.09 | $100.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.08 / $100.09 / $120.39
| Professional | | $90.08 | $100.09 | $120.39 |