- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.68 / $392.79 / $589.57
| Facility | | $378.68 | $392.79 | $589.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.86 / $22.52 / $24.62
| Professional | | $11.86 | $22.52 | $24.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.02 / $21.19 / $24.02
| Professional | | $21.02 | $21.19 | $24.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.87 / $18.61 / $74.04
| Professional | | $14.87 | $18.61 | $74.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.03 / $37.54 / $45.05
| Professional | | $30.03 | $37.54 | $45.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.77 / $13.51 / $22.82
| Professional | | $11.77 | $13.51 | $22.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.02 / $23.87 / $23.87
| Professional | | $15.02 | $23.87 | $23.87 |