- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.77 / $363.39 / $522.34
| Facility | | $300.77 | $363.39 | $522.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.75 / $31.26 / $34.18
| Professional | | $27.75 | $31.26 | $34.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.34 / $33.34 / $41.68
| Professional | | $33.34 | $33.34 | $41.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.72 / $28.91 / $102.21
| Professional | | $22.72 | $28.91 | $102.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.68 / $52.10 / $67.40
| Professional | | $41.68 | $52.10 | $67.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.93 / $21.53 / $37.93
| Professional | | $17.93 | $21.53 | $37.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.84 / $34.45 / $34.45
| Professional | | $20.84 | $34.45 | $34.45 |