- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.94 / $85.58 / $860.22
| Facility | | $26.94 | $85.58 | $860.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.94 / $35.03 / $215.94
| Professional | | $26.94 | $35.03 | $215.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.47 / $28.69 / $47.34
| Professional | | $22.47 | $28.69 | $47.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.62 / $153.44 / $472.06
| Professional | | $24.62 | $153.44 | $472.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.69 / $173.76 / $382.82
| Professional | | $147.69 | $173.76 | $382.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.99 / $228.45 / $430.52
| Professional | | $163.99 | $228.45 | $430.52 |