- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.25 / $116.71 / $249.57
| Facility | | $104.25 | $116.71 | $249.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.48 / $24.18 / $36.27
| Professional | | $12.48 | $24.18 | $36.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.00 / $34.79 / $38.86
| Professional | | $26.00 | $34.79 | $38.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.82 / $20.02 / $25.18
| Professional | | $19.82 | $20.02 | $25.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.26 / $28.63 / $44.02
| Facility | | $12.26 | $28.63 | $44.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.25 / $17.27 / $29.36
| Professional | | $7.25 | $17.27 | $29.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.25 / $17.62 / $24.18
| Professional | | $7.25 | $17.62 | $24.18 |