- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.82 / $299.22 / $330.46
| Facility | | $266.82 | $299.22 | $330.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.04 / $14.81 / $16.57
| Professional | | $13.04 | $14.81 | $16.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $17.78 / $26.86
| Professional | | $16.00 | $17.78 | $26.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $12.98 / $25.56
| Facility | | $10.47 | $12.98 | $25.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $19.18 / $29.60
| Professional | | $10.47 | $19.18 | $29.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.75 / $24.69 / $29.63
| Professional | | $19.75 | $24.69 | $29.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.30 / $8.30 / $8.30
| Facility | | $8.30 | $8.30 | $8.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.89 / $11.08 / $15.01
| Professional | | $8.89 | $11.08 | $15.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.70 / $9.88 / $17.72
| Professional | | $7.70 | $9.88 | $17.72 |