- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.55 / $54.10 / $103.79
| Facility | | $29.55 | $54.10 | $103.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.80 / $15.63 / $16.37
| Professional | | $14.80 | $15.63 | $16.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.26 / $22.20 / $36.61
| Facility | | $21.26 | $22.20 | $36.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.48 / $13.54 / $34.36
| Professional | | $9.48 | $13.54 | $34.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.01 / $43.07 / $75.72
| Facility | | $17.01 | $43.07 | $75.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $19.96 / $25.81
| Professional | | $13.06 | $19.96 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.58 / $13.18 / $35.71
| Professional | | $7.58 | $13.18 | $35.71 |