- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.08 / $154.62 / $231.80
| Facility | | $58.08 | $154.62 | $231.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.57 / $16.89 / $21.32
| Professional | | $13.57 | $16.89 | $21.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.83 / $23.84 / $39.31
| Facility | | $22.83 | $23.84 | $39.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.18 / $14.54 / $36.89
| Professional | | $10.18 | $14.54 | $36.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.26 / $46.26 / $81.31
| Facility | | $18.26 | $46.26 | $81.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.96 / $21.42 / $27.88
| Professional | | $13.96 | $21.42 | $27.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.35 / $13.54 / $31.01
| Professional | | $7.35 | $13.54 | $31.01 |