- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.74 / $184.68 / $272.24
| Facility | | $155.74 | $184.68 | $272.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.42 / $66.54 / $69.23
| Professional | | $30.42 | $66.54 | $69.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.31 / $51.28 / $57.55
| Professional | | $42.31 | $51.28 | $57.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.32 / $29.62 / $37.24
| Professional | | $29.32 | $29.62 | $37.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.07 / $40.04 / $92.52
| Facility | | $18.07 | $40.04 | $92.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.61 / $30.54 / $50.90
| Professional | | $12.61 | $30.54 | $50.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.69 / $30.54 / $36.90
| Professional | | $10.69 | $30.54 | $36.90 |