- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.35 / $50.07 / $130.44
| Facility | | $27.35 | $50.07 | $130.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.53 / $14.93 / $15.15
| Professional | | $14.53 | $14.93 | $15.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.68 / $20.55 / $33.89
| Facility | | $19.68 | $20.55 | $33.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.77 / $12.53 / $31.80
| Professional | | $8.77 | $12.53 | $31.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.76 / $39.89 / $70.12
| Facility | | $15.76 | $39.89 | $70.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.17 / $18.48 / $24.26
| Professional | | $12.17 | $18.48 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.02 / $14.01 / $33.06
| Professional | | $7.02 | $14.01 | $33.06 |