- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.07 / $262.64 / $553.01
| Facility | | $82.07 | $262.64 | $553.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.33 / $68.75 / $98.05
| Professional | | $62.33 | $68.75 | $98.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.49 / $91.66 / $116.41
| Professional | | $82.49 | $91.66 | $116.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.24 / $70.48 / $225.35
| Professional | | $50.24 | $70.48 | $225.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.66 / $109.99 / $174.89
| Professional | | $91.66 | $109.99 | $174.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.33 / $52.53 / $83.41
| Professional | | $40.33 | $52.53 | $83.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.83 / $89.97 / $89.97
| Professional | | $45.83 | $89.97 | $89.97 |