- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.47 / $146.40 / $213.36
| Facility | | $48.47 | $146.40 | $213.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $25.68 / $35.52
| Professional | | $20.72 | $25.68 | $35.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.86 / $36.40 / $60.05
| Facility | | $34.86 | $36.40 | $60.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.54 / $22.20 / $56.37
| Professional | | $15.54 | $22.20 | $56.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.76 / $70.67 / $124.24
| Facility | | $27.76 | $70.67 | $124.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.48 / $32.72 / $42.85
| Professional | | $21.48 | $32.72 | $42.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.43 / $30.45 / $47.60
| Professional | | $12.43 | $30.45 | $47.60 |