- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.61 / $51.27 / $123.43
| Facility | | $30.61 | $51.27 | $123.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.92 / $26.62 / $26.62
| Professional | | $20.92 | $26.62 | $26.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.59 / $26.91 / $177.60
| Professional | | $26.59 | $26.91 | $177.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.02 / $81.02 / $116.06
| Professional | | $30.02 | $81.02 | $116.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.15 / $37.74 / $37.74
| Professional | | $35.15 | $37.74 | $37.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.17 / $40.44 / $85.30
| Professional | | $24.17 | $40.44 | $85.30 |