- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.19 / $526.52 / $776.68
| Facility | | $258.19 | $526.52 | $776.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.03 / $37.03 / $37.03
| Professional | | $37.03 | $37.03 | $37.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.70 / $20.70 / $20.70
| Professional | | $20.70 | $20.70 | $20.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.08 / $59.36 / $144.03
| Facility | | $57.08 | $59.36 | $144.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.86 / $47.08 / $58.85
| Professional | | $24.86 | $47.08 | $58.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.00 / $96.00 / $96.00
| Professional | | $96.00 | $96.00 | $96.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.66 / $22.52 / $43.69
| Professional | | $20.66 | $22.52 | $43.69 |