- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.32 / $125.42 / $244.31
| Facility | | $26.32 | $125.42 | $244.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.32 / $26.32 / $27.37
| Professional | | $26.32 | $26.32 | $27.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.58 / $46.50 / $199.34
| Professional | | $31.58 | $46.50 | $199.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.03 / $59.31 / $127.37
| Facility | | $57.03 | $59.31 | $127.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.03 / $66.28 / $272.33
| Professional | | $26.03 | $66.28 | $272.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.35 / $71.33 / $71.33
| Professional | | $40.35 | $71.33 | $71.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.74 / $21.05 / $76.11
| Professional | | $14.74 | $21.05 | $76.11 |