- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.28 / $59.61 / $153.72
| Facility | | $29.28 | $59.61 | $153.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.67 / $25.26 / $27.52
| Professional | | $21.67 | $25.26 | $27.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.02 / $25.74 / $80.67
| Facility | | $25.02 | $25.74 | $80.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.02 / $33.86 / $42.33
| Professional | | $14.02 | $33.86 | $42.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.28 / $33.67 / $131.75
| Facility | | $29.28 | $33.67 | $131.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.41 / $23.87 / $33.92
| Professional | | $22.41 | $23.87 | $33.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $13.66 / $17.57
| Professional | | $12.30 | $13.66 | $17.57 |