- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.31 / $174.54 / $228.84
| Facility | | $33.31 | $174.54 | $228.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.09 / $23.72 / $33.31
| Professional | | $21.09 | $23.72 | $33.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.37 / $25.06 / $78.55
| Facility | | $24.37 | $25.06 | $78.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.52 / $32.63 / $40.78
| Professional | | $16.52 | $32.63 | $40.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.50 / $32.78 / $118.34
| Facility | | $28.50 | $32.78 | $118.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.82 / $23.33 / $32.72
| Professional | | $21.82 | $23.33 | $32.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.97 / $15.54 / $17.10
| Professional | | $11.97 | $15.54 | $17.10 |