- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.16 / $103.24 / $137.08
| Facility | | $58.16 | $103.24 | $137.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.61 / $48.47 / $71.45
| Professional | | $46.61 | $48.47 | $71.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.20 / $62.14 / $149.13
| Facility | | $20.20 | $62.14 | $149.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.92 / $37.59 / $45.61
| Professional | | $31.92 | $37.59 | $45.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.39 / $72.70 / $224.97
| Facility | | $40.39 | $72.70 | $224.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.45 / $71.45 / $89.31
| Professional | | $71.45 | $71.45 | $89.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.14 / $62.14 / $65.25
| Professional | | $62.14 | $62.14 | $65.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.10 / $33.60 / $68.51
| Professional | | $26.10 | $33.60 | $68.51 |