- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.71 / $156.51 / $292.94
| Facility | | $94.71 | $156.51 | $292.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.19 / $19.47 / $26.10
| Professional | | $19.19 | $19.47 | $26.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.14 / $45.02 / $50.52
| Professional | | $37.14 | $45.02 | $50.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.61 / $25.86 / $32.52
| Professional | | $25.61 | $25.86 | $32.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.41 / $47.15 / $182.22
| Facility | | $21.41 | $47.15 | $182.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.07 / $26.81 / $38.31
| Professional | | $11.07 | $26.81 | $38.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.38 / $31.21 / $38.31
| Professional | | $9.38 | $31.21 | $38.31 |