- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.55 / $343.38 / $564.48
| Facility | | $47.55 | $343.38 | $564.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.70 / $37.34 / $47.12
| Professional | | $31.70 | $37.34 | $47.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.00 / $34.36 / $39.18
| Professional | | $31.00 | $34.36 | $39.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.52 / $33.69 / $105.43
| Professional | | $23.52 | $33.69 | $105.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.84 / $53.55 / $64.26
| Professional | | $42.84 | $53.55 | $64.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.64 / $19.82 / $38.56
| Professional | | $16.64 | $19.82 | $38.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.42 / $42.04 / $42.04
| Professional | | $21.42 | $42.04 | $42.04 |