- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.34 / $107.93 / $250.45
| Facility | | $58.34 | $107.93 | $250.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.72 / $61.45 / $73.89
| Professional | | $51.72 | $61.45 | $73.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.91 / $51.46 / $77.78
| Professional | | $26.91 | $51.46 | $77.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.36 / $151.77 / $243.81
| Facility | | $33.36 | $151.77 | $243.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.22 / $35.49 / $111.51
| Professional | | $23.22 | $35.49 | $111.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.34 / $369.46 / $369.46
| Facility | | $135.34 | $369.46 | $369.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.93 / $32.67 / $77.78
| Professional | | $25.93 | $32.67 | $77.78 |