- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.36 / $51.36 / $132.07
| Facility | | $51.36 | $51.36 | $132.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.69 / $64.22 / $213.60
| Professional | | $47.69 | $64.22 | $213.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.45 / $147.84 / $165.08
| Professional | | $110.45 | $147.84 | $165.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.25 / $84.25 / $123.69
| Professional | | $84.25 | $84.25 | $123.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.32 / $57.23 / $134.32
| Facility | | $45.32 | $57.23 | $134.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.75 / $99.54 / $146.74
| Professional | | $42.75 | $99.54 | $146.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.82 / $74.84 / $124.73
| Professional | | $30.82 | $74.84 | $124.73 |