- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.32 / $211.65 / $237.27
| Facility | | $61.32 | $211.65 | $237.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.32 / $27.37 / $63.69
| Professional | | $26.32 | $27.37 | $63.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.07 / $38.50 / $196.65
| Professional | | $28.07 | $38.50 | $196.65 |
- 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
- $28.85 / $52.06 / $272.33
| Professional | | $28.85 | $52.06 | $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
- $21.05 / $28.94 / $52.66
| Professional | | $21.05 | $28.94 | $52.66 |