- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.52 / $143.59 / $267.26
| Facility | | $25.52 | $143.59 | $267.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.98 / $20.98 / $32.78
| Professional | | $20.98 | $20.98 | $32.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.66 / $171.36 / $172.65
| Professional | | $145.66 | $171.36 | $172.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.74 / $30.03 / $37.76
| Professional | | $29.74 | $30.03 | $37.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.54 / $36.86 / $150.53
| Facility | | $18.54 | $36.86 | $150.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.29 / $27.04 / $61.97
| Professional | | $12.29 | $27.04 | $61.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.12 / $29.50 / $51.03
| Professional | | $14.12 | $29.50 | $51.03 |