- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.65 / $238.58 / $429.62
| Facility | | $52.65 | $238.58 | $429.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.65 / $52.65 / $73.65
| Professional | | $52.65 | $52.65 | $73.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.16 / $63.18 / $347.51
| Professional | | $56.16 | $63.18 | $347.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.08 / $118.64 / $254.74
| Facility | | $114.08 | $118.64 | $254.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.89 / $110.93 / $547.37
| Professional | | $51.89 | $110.93 | $547.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.73 / $142.69 / $142.69
| Professional | | $80.73 | $142.69 | $142.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.48 / $42.12 / $137.79
| Professional | | $29.48 | $42.12 | $137.79 |