- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.08 / $137.29 / $254.74
| Facility | | $37.08 | $137.29 | $254.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.32 / $24.89 / $37.08
| Professional | | $19.32 | $24.89 | $37.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.02 / $25.74 / $80.67
| Facility | | $25.02 | $25.74 | $80.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.39 / $33.86 / $42.33
| Professional | | $18.39 | $33.86 | $42.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.28 / $33.67 / $131.75
| Facility | | $29.28 | $33.67 | $131.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.41 / $23.87 / $33.92
| Professional | | $22.41 | $23.87 | $33.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $17.30 / $17.57
| Professional | | $12.30 | $17.30 | $17.57 |