- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.30 / $71.20 / $205.21
| Facility | | $57.30 | $71.20 | $205.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $42.13 / $46.34
| Professional | | $20.00 | $42.13 | $46.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.86 / $66.31 / $110.28
| Facility | | $16.86 | $66.31 | $110.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.17 / $33.70 / $48.03
| Professional | | $23.17 | $33.70 | $48.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.24 / $35.32 / $90.26
| Facility | | $28.24 | $35.32 | $90.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.26 / $42.13 / $73.88
| Professional | | $27.26 | $42.13 | $73.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.31 / $42.31 / $244.29
| Facility | | $42.31 | $42.31 | $244.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.59 / $18.72 / $33.70
| Professional | | $17.59 | $18.72 | $33.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.59 / $18.72 / $33.70
| Professional | | $17.59 | $18.72 | $33.70 |