- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.67 / $108.31 / $318.86
| Facility | | $20.67 | $108.31 | $318.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.48 / $17.23 / $22.97
| Professional | | $12.48 | $17.23 | $22.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.63 / $20.19 / $63.29
| Facility | | $19.63 | $20.19 | $63.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.43 / $26.43 / $33.04
| Professional | | $26.43 | $26.43 | $33.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.97 / $26.42 / $93.03
| Facility | | $22.97 | $26.42 | $93.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.59 / $18.72 / $26.33
| Professional | | $17.59 | $18.72 | $26.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.65 / $9.65 / $13.78
| Professional | | $9.65 | $9.65 | $13.78 |