- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.59 / $72.62 / $327.30
| Facility | | $21.59 | $72.62 | $327.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.88 / $53.71 / $78.30
| Professional | | $16.88 | $53.71 | $78.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.92 / $73.23 / $115.15
| Professional | | $22.92 | $73.23 | $115.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.85 / $58.74 / $73.36
| Professional | | $45.85 | $58.74 | $73.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.03 / $39.63 / $106.64
| Professional | | $21.03 | $39.63 | $106.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.21 / $76.40 / $115.25
| Professional | | $59.21 | $76.40 | $115.25 |