- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.80 / $134.10 / $177.73
| Facility | | $10.80 | $134.10 | $177.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.58 / $15.12 / $22.07
| Professional | | $12.58 | $15.12 | $22.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.77 / $22.64 / $27.67
| Facility | | $16.77 | $22.64 | $27.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.77 / $20.96 / $22.64
| Professional | | $16.77 | $20.96 | $22.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.63 / $30.43 / $50.30
| Facility | | $13.63 | $30.43 | $50.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.58 / $24.26 / $106.51
| Professional | | $9.58 | $24.26 | $106.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.40 / $99.22 / $237.77
| Facility | | $14.40 | $99.22 | $237.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $18.45 / $28.33
| Professional | | $10.06 | $18.45 | $28.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.04 / $10.06 / $33.06
| Professional | | $7.04 | $10.06 | $33.06 |