- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $157.55 / $171.60
| Facility | | $41.69 | $157.55 | $171.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.10 / $21.78 / $23.08
| Professional | | $19.10 | $21.78 | $23.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $31.33 / $51.65
| Facility | | $30.00 | $31.33 | $51.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.37 / $19.10 / $48.47
| Professional | | $13.37 | $19.10 | $48.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.76 / $60.79 / $106.87
| Facility | | $23.76 | $60.79 | $106.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.43 / $28.15 / $36.65
| Professional | | $18.43 | $28.15 | $36.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $18.59 / $40.75
| Professional | | $5.25 | $18.59 | $40.75 |