- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.56 / $87.23 / $161.86
| Facility | | $23.56 | $87.23 | $161.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.84 / $22.66 / $30.47
| Professional | | $18.84 | $22.66 | $30.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.78 / $22.40 / $70.20
| Facility | | $21.78 | $22.40 | $70.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.05 / $29.32 / $36.65
| Professional | | $16.05 | $29.32 | $36.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.48 / $29.30 / $114.66
| Facility | | $25.48 | $29.30 | $114.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $20.89 / $29.53
| Professional | | $19.50 | $20.89 | $29.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $14.58 / $15.29
| Professional | | $10.70 | $14.58 | $15.29 |