- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.27 / $55.42 / $115.86
| Facility | | $30.27 | $55.42 | $115.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.52 / $16.52 / $18.67
| Professional | | $16.52 | $16.52 | $18.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.73 / $24.78 / $25.79
| Facility | | $23.73 | $24.78 | $25.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.11 / $15.11 / $34.95
| Professional | | $15.11 | $15.11 | $34.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.14 / $54.54 / $77.59
| Facility | | $44.14 | $54.54 | $77.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.53 / $23.13 / $28.91
| Professional | | $12.53 | $23.13 | $28.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.05 / $12.62 / $32.24
| Professional | | $7.05 | $12.62 | $32.24 |