- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.38 / $68.09 / $232.89
| Facility | | $53.38 | $68.09 | $232.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.22 / $15.47 / $17.42
| Professional | | $12.22 | $15.47 | $17.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.17 / $37.56 / $42.15
| Professional | | $28.17 | $37.56 | $42.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.48 / $21.69 / $27.27
| Professional | | $21.48 | $21.69 | $27.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.23 / $27.96 / $263.68
| Facility | | $13.23 | $27.96 | $263.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $18.64 / $31.69
| Professional | | $7.83 | $18.64 | $31.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $9.51 / $26.10
| Professional | | $7.83 | $9.51 | $26.10 |