- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.59 / $346.05 / $398.05
| Facility | | $31.59 | $346.05 | $398.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.36 / $31.59 / $112.25
| Professional | | $17.36 | $31.59 | $112.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.43 / $35.33 / $58.39
| Professional | | $21.43 | $35.33 | $58.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.67 / $45.07 / $228.56
| Professional | | $13.67 | $45.07 | $228.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.21 / $51.33 / $68.69
| Professional | | $29.21 | $51.33 | $68.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.94 / $27.20 / $40.02
| Professional | | $21.94 | $27.20 | $40.02 |