- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.21 / $237.91 / $375.73
| Facility | | $42.21 | $237.91 | $375.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.52 / $70.00 / $98.89
| Professional | | $28.52 | $70.00 | $98.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.04 / $62.74 / $218.64
| Professional | | $57.04 | $62.74 | $218.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $40.47 / $164.58
| Professional | | $30.23 | $40.47 | $164.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.04 / $68.45 / $85.56
| Professional | | $57.04 | $68.45 | $85.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.96 / $26.24 / $51.91
| Professional | | $23.96 | $26.24 | $51.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.52 / $45.35 / $45.35
| Professional | | $28.52 | $45.35 | $45.35 |