- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.84 / $58.30 / $77.41
| Facility | | $32.84 | $58.30 | $77.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.64 / $27.37 / $68.43
| Professional | | $19.64 | $27.37 | $68.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.62 / $35.09 / $43.86
| Facility | | $15.62 | $35.09 | $43.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.10 / $19.10 / $23.87
| Professional | | $19.10 | $19.10 | $23.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.81 / $41.06 / $127.05
| Facility | | $22.81 | $41.06 | $127.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.07 / $42.46 / $50.88
| Professional | | $28.07 | $42.46 | $50.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.77 / $35.09 / $36.84
| Professional | | $8.77 | $35.09 | $36.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.64 / $52.64 / $52.64
| Facility | | $52.64 | $52.64 | $52.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.74 / $14.74 / $55.13
| Professional | | $14.74 | $14.74 | $55.13 |