- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.03 / $238.47 / $464.23
| Facility | | $50.03 | $238.47 | $464.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.03 / $50.03 / $50.03
| Professional | | $50.03 | $50.03 | $50.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.36 / $291.58 / $670.07
| Professional | | $53.36 | $291.58 | $670.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.40 / $112.74 / $242.83
| Facility | | $108.40 | $112.74 | $242.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.52 / $76.41 / $95.51
| Professional | | $36.52 | $76.41 | $95.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.58 / $135.58 / $135.58
| Professional | | $135.58 | $135.58 | $135.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.13 / $44.92 / $60.70
| Professional | | $39.13 | $44.92 | $60.70 |