- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.45 / $884.46 / $1,056.81
| Facility | | $86.45 | $884.46 | $1,056.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.03 / $23.21 / $27.36
| Professional | | $17.03 | $23.21 | $27.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.07 / $22.69 / $71.13
| Facility | | $22.07 | $22.69 | $71.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.21 / $29.74 / $37.17
| Professional | | $16.21 | $29.74 | $37.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.81 / $29.68 / $116.11
| Facility | | $25.81 | $29.68 | $116.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.76 / $21.16 / $29.92
| Professional | | $19.76 | $21.16 | $29.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $14.77 / $15.49
| Professional | | $10.84 | $14.77 | $15.49 |