- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.81 / $180.18 / $350.80
| Facility | | $37.81 | $180.18 | $350.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.81 / $37.81 / $37.81
| Professional | | $37.81 | $37.81 | $37.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.33 / $220.38 / $506.42
| Professional | | $40.33 | $220.38 | $506.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.93 / $85.20 / $183.32
| Facility | | $81.93 | $85.20 | $183.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.53 / $57.82 / $72.28
| Professional | | $27.53 | $57.82 | $72.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.47 / $102.47 / $102.47
| Professional | | $102.47 | $102.47 | $102.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.57 / $45.87 / $45.87
| Professional | | $29.57 | $45.87 | $45.87 |