- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.12 / $211.48 / $392.41
| Facility | | $57.12 | $211.48 | $392.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.47 / $69.38 / $115.53
| Professional | | $46.47 | $69.38 | $115.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.45 / $2.52 / $7.88
| Facility | | $2.45 | $2.52 | $7.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.51 / $47.63 / $180.62
| Professional | | $34.51 | $47.63 | $180.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.00 / $76.04 / $110.81
| Facility | | $56.00 | $76.04 | $110.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.52 / $98.52 / $133.97
| Professional | | $86.52 | $98.52 | $133.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.02 / $43.35 / $57.12
| Professional | | $28.02 | $43.35 | $57.12 |