- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.31 / $101.96 / $386.36
| Facility | | $52.31 | $101.96 | $386.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $18.71 / $75.05
| Professional | | $13.06 | $18.71 | $75.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.38 / $15.38 / $15.38
| Professional | | $15.38 | $15.38 | $15.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.53 / $44.54 / $46.87
| Professional | | $36.53 | $44.54 | $46.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.75 / $16.96 / $22.13
| Professional | | $14.75 | $16.96 | $22.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.30 / $23.19 / $41.93
| Professional | | $13.30 | $23.19 | $41.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.75 / $14.75 / $16.96
| Professional | | $14.75 | $14.75 | $16.96 |