- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.62 / $50.56 / $132.13
| Facility | | $27.62 | $50.56 | $132.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $16.48 / $18.84
| Professional | | $15.00 | $16.48 | $18.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.95 / $27.07 / $34.21
| Facility | | $22.95 | $27.07 | $34.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $17.23 / $32.10
| Professional | | $12.07 | $17.23 | $32.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.76 / $40.26 / $70.78
| Facility | | $15.76 | $40.26 | $70.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.17 / $18.64 / $33.04
| Professional | | $12.17 | $18.64 | $33.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.65 / $21.00 / $36.77
| Professional | | $9.65 | $21.00 | $36.77 |