- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.28 / $77.62 / $160.10
| Facility | | $34.28 | $77.62 | $160.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.18 / $33.95 / $37.72
| Professional | | $30.18 | $33.95 | $37.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.72 / $41.50 / $130.43
| Facility | | $37.72 | $41.50 | $130.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.97 / $18.63 / $32.06
| Professional | | $16.97 | $18.63 | $32.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.40 / $63.14 / $120.00
| Facility | | $26.40 | $63.14 | $120.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.69 / $43.37 / $56.13
| Professional | | $23.69 | $43.37 | $56.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.38 / $37.72 / $47.43
| Facility | | $28.38 | $37.72 | $47.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $22.64 / $52.70
| Professional | | $15.85 | $22.64 | $52.70 |