- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.74 / $330.11 / $515.79
| Facility | | $182.74 | $330.11 | $515.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.57 / $33.86 / $147.37
| Professional | | $30.57 | $33.86 | $147.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.27 / $3.27 / $3.27
| Facility | | $3.27 | $3.27 | $3.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.07 / $31.27 / $108.20
| Professional | | $15.07 | $31.27 | $108.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.32 / $147.37 / $427.37
| Facility | | $31.32 | $147.37 | $427.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.24 / $39.24 / $56.05
| Professional | | $39.24 | $39.24 | $56.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.27 / $147.37 / $210.74
| Facility | | $3.27 | $147.37 | $210.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.07 / $39.24 / $56.05
| Professional | | $15.07 | $39.24 | $56.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.28 / $95.22 / $114.67
| Professional | | $26.28 | $95.22 | $114.67 |