- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.31 / $185.04 / $208.62
| Facility | | $103.31 | $185.04 | $208.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.28 / $41.97 / $49.71
| Professional | | $31.28 | $41.97 | $49.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.82 / $70.70 / $79.23
| Professional | | $52.82 | $70.70 | $79.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.06 / $40.06 / $58.81
| Professional | | $40.06 | $40.06 | $58.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.56 / $34.97 / $158.36
| Facility | | $24.56 | $34.97 | $158.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $50.88 / $70.18
| Professional | | $21.05 | $50.88 | $70.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.74 / $35.79 / $60.18
| Professional | | $14.74 | $35.79 | $60.18 |