- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.73 / $139.01 / $209.83
| Facility | | $85.73 | $139.01 | $209.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $25.68 / $36.54
| Professional | | $20.72 | $25.68 | $36.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.30 / $26.02 / $81.56
| Facility | | $25.30 | $26.02 | $81.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.70 / $34.28 / $42.85
| Professional | | $18.70 | $34.28 | $42.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.60 / $34.04 / $133.19
| Facility | | $29.60 | $34.04 | $133.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.65 / $24.15 / $34.31
| Professional | | $22.65 | $24.15 | $34.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.43 / $17.61 / $17.76
| Professional | | $12.43 | $17.61 | $17.76 |