- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.51 / $120.51 / $161.47
| Facility | | $120.51 | $120.51 | $161.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.02 / $96.73 / $135.66
| Professional | | $72.02 | $96.73 | $135.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.40 / $42.96 / $57.80
| Facility | | $35.40 | $42.96 | $57.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.67 / $55.83 / $65.88
| Professional | | $43.67 | $55.83 | $65.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.74 / $53.73 / $346.07
| Facility | | $2.74 | $53.73 | $346.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.46 / $60.05 / $240.38
| Professional | | $32.46 | $60.05 | $240.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.18 / $51.08 / $72.66
| Professional | | $36.18 | $51.08 | $72.66 |