- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $269.15 / $977.24
| Facility | | $56.23 | $269.15 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $102.33
| Professional | | $52.48 | $52.48 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.70 / $79.43 / $162.18
| Facility | | $53.70 | $79.43 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $81.28
| Professional | | $52.48 | $52.48 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $45.71 / $128.82
| Facility | | $45.71 | $45.71 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $53.70 / $69.18
| Professional | | $45.71 | $53.70 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $102.33
| Facility | | $52.48 | $52.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $61.66
| Professional | | $52.48 | $52.48 | $61.66 |