- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.08 / $143.91 / $209.86
| Facility | | $77.08 | $143.91 | $209.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.55 / $24.96 / $33.53
| Professional | | $19.55 | $24.96 | $33.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.88 / $24.56 / $76.98
| Facility | | $23.88 | $24.56 | $76.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.61 / $31.80 / $39.75
| Professional | | $17.61 | $31.80 | $39.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.94 / $32.13 / $125.71
| Facility | | $27.94 | $32.13 | $125.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $22.79 / $32.32
| Professional | | $21.38 | $22.79 | $32.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.73 / $16.62 / $16.76
| Professional | | $11.73 | $16.62 | $16.76 |