- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.32 / $219.72 / $239.45
| Facility | | $118.32 | $219.72 | $239.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.30 / $43.93 / $247.90
| Professional | | $16.30 | $43.93 | $247.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.78 / $62.06 / $103.21
| Facility | | $15.78 | $62.06 | $103.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.34 / $23.76 / $33.86
| Professional | | $16.34 | $23.76 | $33.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.16 / $51.96 / $103.46
| Facility | | $3.16 | $51.96 | $103.46 |