- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.84 / $91.38 / $842.46
| Facility | | $42.84 | $91.38 | $842.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.70 / $28.70 / $35.56
| Professional | | $28.70 | $28.70 | $35.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.85 / $27.85 / $27.85
| Facility | | $27.85 | $27.85 | $27.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.72 / $34.61 / $85.94
| Professional | | $30.72 | $34.61 | $85.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.56 / $113.95 / $207.40
| Facility | | $108.56 | $113.95 | $207.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.98 / $35.90 / $94.25
| Professional | | $17.98 | $35.90 | $94.25 |