- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.87 / $76.06 / $277.22
| Facility | | $55.87 | $76.06 | $277.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.53 / $58.51 / $68.52
| Professional | | $39.53 | $58.51 | $68.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.07 / $102.94 / $162.19
| Facility | | $57.07 | $102.94 | $162.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.26 / $42.45 / $401.36
| Facility | | $34.26 | $42.45 | $401.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.94 / $60.71 / $75.89
| Professional | | $27.94 | $60.71 | $75.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.08 / $26.36 / $63.00
| Professional | | $21.08 | $26.36 | $63.00 |