- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.78 / $131.94 / $246.35
| Facility | | $59.78 | $131.94 | $246.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.67 / $26.35 / $26.55
| Professional | | $21.67 | $26.35 | $26.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.72 / $27.02 / $43.52
| Professional | | $23.72 | $27.02 | $43.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.52 / $20.25 / $37.89
| Facility | | $15.52 | $20.25 | $37.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.52 / $31.10 / $47.89
| Professional | | $15.52 | $31.10 | $47.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.28 / $36.60 / $43.92
| Professional | | $29.28 | $36.60 | $43.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $17.57 / $26.64
| Professional | | $13.18 | $17.57 | $26.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.42 / $14.64 / $28.73
| Professional | | $11.42 | $14.64 | $28.73 |