- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.31 / $59.05 / $147.26
| Facility | | $51.31 | $59.05 | $147.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.31 / $51.31 / $53.87
| Professional | | $51.31 | $51.31 | $53.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.22 / $175.03 / $235.48
| Facility | | $144.22 | $175.03 | $235.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.68 / $38.47 / $45.41
| Professional | | $31.68 | $38.47 | $45.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.35 / $43.36 / $163.58
| Facility | | $40.35 | $43.36 | $163.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.19 / $35.61 / $59.57
| Professional | | $25.19 | $35.61 | $59.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.79 / $30.79 / $51.31
| Professional | | $30.79 | $30.79 | $51.31 |