- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.53 / $37.72 / $80.48
| Facility | | $30.53 | $37.72 | $80.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.81 / $31.32 / $31.32
| Professional | | $29.81 | $31.32 | $31.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.52 / $24.52 / $24.52
| Facility | | $24.52 | $24.52 | $24.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $43.37 / $70.68
| Professional | | $27.00 | $43.37 | $70.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.58 / $92.81 / $182.66
| Facility | | $21.58 | $92.81 | $182.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $22.64 / $52.70
| Professional | | $15.85 | $22.64 | $52.70 |