- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.07 / $76.50 / $110.47
| Facility | | $52.07 | $76.50 | $110.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.45 / $23.45 / $37.74
| Professional | | $23.45 | $23.45 | $37.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.03 / $82.73 / $137.60
| Facility | | $21.03 | $82.73 | $137.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.80 / $31.68 / $45.14
| Professional | | $19.80 | $31.68 | $45.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.16 / $51.96 / $103.46
| Facility | | $3.16 | $51.96 | $103.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.13 / $15.13 / $15.13
| Professional | | $15.13 | $15.13 | $15.13 |