- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.37 / $325.75 / $476.28
| Facility | | $196.37 | $325.75 | $476.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.60 / $26.32 / $41.97
| Professional | | $18.60 | $26.32 | $41.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.07 / $31.58 / $41.68
| Professional | | $28.07 | $31.58 | $41.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.30 / $32.44 / $86.11
| Professional | | $19.30 | $32.44 | $86.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.09 / $43.86 / $66.95
| Professional | | $35.09 | $43.86 | $66.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $29.42 / $43.33
| Professional | | $21.05 | $29.42 | $43.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.45 / $34.45 / $34.45
| Professional | | $34.45 | $34.45 | $34.45 |