- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.25 / $155.08 / $375.70
| Facility | | $52.25 | $155.08 | $375.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.46 / $51.54 / $126.44
| Professional | | $45.46 | $51.54 | $126.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.30 / $56.46 / $101.53
| Professional | | $50.30 | $56.46 | $101.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.44 / $476.38 / $729.07
| Facility | | $418.44 | $476.38 | $729.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.61 / $65.02 / $226.07
| Professional | | $40.61 | $65.02 | $226.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.96 / $67.11 / $129.22
| Professional | | $57.96 | $67.11 | $129.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.04 / $58.86 / $163.74
| Professional | | $37.04 | $58.86 | $163.74 |