- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.65 / $228.76 / $510.41
| Facility | | $41.65 | $228.76 | $510.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.09 / $66.54 / $88.72
| Professional | | $33.09 | $66.54 | $88.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.98 / $31.30 / $51.61
| Facility | | $29.98 | $31.30 | $51.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $19.09 / $48.42
| Professional | | $13.36 | $19.09 | $48.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.76 / $60.74 / $106.78
| Facility | | $23.76 | $60.74 | $106.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.20 / $19.55 / $36.65
| Professional | | $15.20 | $19.55 | $36.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $21.32 / $40.72
| Professional | | $5.25 | $21.32 | $40.72 |