- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.06 / $129.54 / $249.66
| Facility | | $95.06 | $129.54 | $249.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $90.24 / $126.54
| Professional | | $89.34 | $90.24 | $126.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.99 / $146.84 / $346.01
| Facility | | $91.99 | $146.84 | $346.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $89.34 / $89.34
| Professional | | $89.34 | $89.34 | $89.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.34 / $89.34 / $89.34
| Facility | | $89.34 | $89.34 | $89.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $89.34 / $89.34
| Professional | | $89.34 | $89.34 | $89.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.72 / $92.72 / $125.09
| Professional | | $92.72 | $92.72 | $125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.87 / $89.34 / $99.45
| Professional | | $84.87 | $89.34 | $99.45 |