- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.44 / $68.72 / $216.24
| Facility | | $58.44 | $68.72 | $216.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $10.19
| Professional | | $10.00 | $10.00 | $10.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $428.00 / $537.72
| Professional | | $70.00 | $428.00 | $537.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.71 / $103.26 / $168.47
| Facility | | $10.71 | $103.26 | $168.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.71 / $15.71 / $15.71
| Professional | | $15.71 | $15.71 | $15.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.61 / $168.38 / $344.54
| Facility | | $142.61 | $168.38 | $344.54 |