- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.81 / $61.54 / $192.36
| Facility | | $23.81 | $61.54 | $192.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.22 / $22.47 / $22.91
| Professional | | $20.22 | $22.47 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.27 / $32.29 / $87.43
| Facility | | $25.27 | $32.29 | $87.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.22 / $12.48 / $28.26
| Professional | | $12.22 | $12.48 | $28.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.66 / $40.91 / $81.36
| Facility | | $17.66 | $40.91 | $81.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.97 / $28.91 / $37.08
| Professional | | $15.97 | $28.91 | $37.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.52 / $28.52 / $28.52
| Facility | | $28.52 | $28.52 | $28.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $15.16 / $35.31
| Professional | | $10.61 | $15.16 | $35.31 |