- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.14 / $89.06 / $180.37
| Facility | | $48.14 | $89.06 | $180.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.14 / $50.71 / $57.13
| Professional | | $48.14 | $50.71 | $57.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.38 / $41.72 / $102.70
| Professional | | $33.38 | $41.72 | $102.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.55 / $127.11 / $183.57
| Facility | | $42.55 | $127.11 | $183.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.51 / $78.06 / $97.58
| Professional | | $73.51 | $78.06 | $97.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.69 / $304.89 / $304.89
| Facility | | $111.69 | $304.89 | $304.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.68 / $38.51 / $64.19
| Professional | | $25.68 | $38.51 | $64.19 |