- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $72.44 / $1,905.46
| Facility | | $33.11 | $72.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $104.71
| Professional | | $30.20 | $44.67 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Facility | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $87.10 / $144.54
| Professional | | $70.79 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $50.12 / $107.15
| Professional | | $39.81 | $50.12 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $70.79 / $109.65
| Professional | | $52.48 | $70.79 | $109.65 |