- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.35 / $51.24 / $116.76
| Facility | | $26.35 | $51.24 | $116.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.25 / $25.51 / $27.52
| Professional | | $22.25 | $25.51 | $27.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.28 / $32.53 / $101.31
| Facility | | $29.28 | $32.53 | $101.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.01 / $17.55 / $29.63
| Professional | | $13.01 | $17.55 | $29.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.08 / $43.01 / $85.35
| Facility | | $20.08 | $43.01 | $85.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.31 / $33.86 / $43.01
| Professional | | $15.31 | $33.86 | $43.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.28 / $29.28 / $29.28
| Facility | | $29.28 | $29.28 | $29.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $17.57 / $33.34
| Professional | | $12.30 | $17.57 | $33.34 |