- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.50 / $153.61 / $443.81
| Facility | | $25.50 | $153.61 | $443.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.78 / $21.71 / $25.81
| Professional | | $16.78 | $21.71 | $25.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.26 / $51.00 / $53.12
| Facility | | $44.26 | $51.00 | $53.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.26 / $40.00 / $83.00
| Professional | | $32.26 | $40.00 | $83.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.64 / $51.64 / $51.64
| Facility | | $51.64 | $51.64 | $51.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.79 / $29.74 / $37.17
| Professional | | $15.79 | $29.74 | $37.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $14.91 / $36.08
| Professional | | $10.84 | $14.91 | $36.08 |