- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $660.69 / $1,288.25
| Facility | | $38.02 | $660.69 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $60.26 / $363.08
| Professional | | $22.39 | $60.26 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $26.92 / $45.71
| Professional | | $1.66 | $26.92 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.55 / $9.55 / $10.47
| Facility | | $9.55 | $9.55 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Facility | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Professional | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $28.84 / $31.62
| Facility | | $28.84 | $28.84 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $31.62 / $48.98
| Professional | | $26.92 | $31.62 | $48.98 |