- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $275.42 / $295.12
| Facility | | $102.33 | $275.42 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $79.43 / $91.20
| Professional | | $57.54 | $79.43 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $245.47 / $331.13
| Facility | | $199.53 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $67.61 / $107.15
| Professional | | $67.61 | $67.61 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $177.83 / $229.09
| Facility | | $114.82 | $177.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $81.28 / $281.84
| Professional | | $70.79 | $81.28 | $281.84 |