- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.67 / $165.95 / $217.57
| Facility | | $31.67 | $165.95 | $217.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.91 / $21.72 / $31.67
| Professional | | $18.91 | $21.72 | $31.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.84 / $22.46 / $70.41
| Facility | | $21.84 | $22.46 | $70.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.74 / $29.32 / $36.65
| Professional | | $15.74 | $29.32 | $36.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.55 / $29.38 / $112.51
| Facility | | $25.55 | $29.38 | $112.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.55 / $20.89 / $29.53
| Professional | | $19.55 | $20.89 | $29.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $10.73 / $15.33
| Professional | | $10.73 | $10.73 | $15.33 |