- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.36 / $92.05 / $357.38
| Facility | | $88.36 | $92.05 | $357.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.43 / $42.23 / $76.84
| Professional | | $27.43 | $42.23 | $76.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.32 / $28.37 / $52.50
| Professional | | $15.32 | $28.37 | $52.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.68 / $53.36 / $120.61
| Professional | | $22.68 | $53.36 | $120.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.33 / $77.90 / $161.13
| Professional | | $33.33 | $77.90 | $161.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.15 / $53.95 / $73.68
| Professional | | $42.15 | $53.95 | $73.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.78 / $37.49 / $57.05
| Professional | | $23.78 | $37.49 | $57.05 |