- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.51 / $374.71 / $491.27
| Facility | | $71.51 | $374.71 | $491.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.05 / $31.08 / $71.51
| Professional | | $27.05 | $31.08 | $71.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.24 / $32.13 / $100.72
| Facility | | $31.24 | $32.13 | $100.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.53 / $42.13 / $52.66
| Professional | | $35.53 | $42.13 | $52.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.56 / $42.04 / $170.00
| Facility | | $36.56 | $42.04 | $170.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.98 / $29.85 / $42.29
| Professional | | $27.98 | $29.85 | $42.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.36 / $21.94 / $33.59
| Professional | | $15.36 | $21.94 | $33.59 |