- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $61.66 / $104.71
| Facility | | $12.02 | $61.66 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.88 / $75.86
| Professional | | $12.02 | $12.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $85.11 / $186.21
| Professional | | $47.86 | $85.11 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.54 / $28.84 / $64.57
| Facility | | $27.54 | $28.84 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $19.95 / $24.55
| Professional | | $9.33 | $19.95 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $34.67
| Professional | | $32.36 | $32.36 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $20.42
| Facility | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $10.72 / $28.84
| Professional | | $7.08 | $10.72 | $28.84 |