- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.21 / $62.14 / $307.69
| Facility | | $23.21 | $62.14 | $307.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.98 / $36.42 / $77.09
| Professional | | $21.98 | $36.42 | $77.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.50 / $52.10 / $110.06
| Professional | | $24.50 | $52.10 | $110.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.35 / $68.00 / $103.70
| Professional | | $26.35 | $68.00 | $103.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.21 / $53.92 / $78.72
| Facility | | $23.21 | $53.92 | $78.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.42 / $98.10 / $476.90
| Professional | | $64.42 | $98.10 | $476.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.91 / $83.37 / $121.80
| Professional | | $62.91 | $83.37 | $121.80 |