- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.31 / $109.30 / $318.14
| Facility | | $46.31 | $109.30 | $318.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.06 / $31.65 / $46.31
| Professional | | $27.06 | $31.65 | $46.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.26 / $32.15 / $100.76
| Facility | | $31.26 | $32.15 | $100.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.06 / $42.13 / $52.66
| Professional | | $23.06 | $42.13 | $52.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.57 / $42.06 / $164.55
| Facility | | $36.57 | $42.06 | $164.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.99 / $29.85 / $42.29
| Professional | | $27.99 | $29.85 | $42.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.36 / $21.61 / $21.94
| Professional | | $15.36 | $21.61 | $21.94 |