- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.86 / $334.51 / $485.28
| Facility | | $26.86 | $334.51 | $485.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.94 / $28.01 / $105.30
| Professional | | $23.94 | $28.01 | $105.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.51 / $60.04 / $70.39
| Professional | | $50.51 | $60.04 | $70.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.75 / $31.06 / $38.44
| Professional | | $27.75 | $31.06 | $38.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.17 / $34.06 / $50.67
| Facility | | $26.17 | $34.06 | $50.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.88 / $53.62 / $161.03
| Professional | | $29.88 | $53.62 | $161.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.95 / $53.01 / $75.36
| Professional | | $29.95 | $53.01 | $75.36 |