- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.82 / $292.02 / $541.14
| Facility | | $190.82 | $292.02 | $541.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.00 / $24.84 / $33.13
| Professional | | $19.00 | $24.84 | $33.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.54 / $44.52 / $77.52
| Facility | | $31.54 | $44.52 | $77.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.08 / $31.54 / $51.38
| Professional | | $22.08 | $31.54 | $51.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.77 / $81.81 / $143.82
| Facility | | $29.77 | $81.81 | $143.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.48 / $26.06 / $58.85
| Professional | | $21.48 | $26.06 | $58.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.50 / $21.98 / $71.34
| Professional | | $10.50 | $21.98 | $71.34 |