- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.06 / $325.45 / $765.55
| Facility | | $147.06 | $325.45 | $765.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.64 / $11.33 / $16.73
| Professional | | $10.64 | $11.33 | $16.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.24 / $25.95 / $30.53
| Professional | | $23.24 | $25.95 | $30.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.16 / $26.93 / $38.58
| Professional | | $18.16 | $26.93 | $38.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.22 / $18.62 / $221.19
| Facility | | $10.22 | $18.62 | $221.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.91 / $19.52 / $25.45
| Professional | | $11.91 | $19.52 | $25.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.40 / $19.17 / $23.57
| Professional | | $9.40 | $19.17 | $23.57 |