- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $229.09 / $331.13
| Facility | | $208.93 | $229.09 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $20.89 / $69.18
| Professional | | $16.22 | $20.89 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $21.38 / $24.55
| Professional | | $3.55 | $21.38 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $17.38 / $34.67
| Facility | | $12.02 | $17.38 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $13.80 / $61.66
| Professional | | $12.02 | $13.80 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $29.51 / $39.81
| Professional | | $26.92 | $29.51 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $12.59 / $20.42
| Facility | | $11.22 | $12.59 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.89 / $12.59 / $24.55
| Professional | | $5.89 | $12.59 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $21.38 / $39.81
| Professional | | $10.47 | $21.38 | $39.81 |