- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.55 / $128.65 / $252.11
| Facility | | $91.55 | $128.65 | $252.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.60 / $45.42 / $46.10
| Professional | | $35.60 | $45.42 | $46.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.55 / $102.48 / $115.01
| Professional | | $84.55 | $102.48 | $115.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.23 / $58.82 / $73.95
| Professional | | $58.23 | $58.82 | $73.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.60 / $78.80 / $242.94
| Facility | | $35.60 | $78.80 | $242.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.36 / $61.03 / $87.20
| Professional | | $21.36 | $61.03 | $87.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.36 / $53.40 / $87.20
| Professional | | $21.36 | $53.40 | $87.20 |