- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.88 / $180.49 / $351.57
| Facility | | $37.88 | $180.49 | $351.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.88 / $37.88 / $37.88
| Professional | | $37.88 | $37.88 | $37.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.40 / $220.85 / $507.52
| Professional | | $40.40 | $220.85 | $507.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.08 / $85.36 / $183.32
| Facility | | $82.08 | $85.36 | $183.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.73 / $57.82 / $72.28
| Professional | | $27.73 | $57.82 | $72.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.65 / $102.65 / $102.65
| Professional | | $102.65 | $102.65 | $102.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.21 / $30.97 / $45.95
| Professional | | $21.21 | $30.97 | $45.95 |