- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.56 / $54.12 / $253.17
| Facility | | $29.56 | $54.12 | $253.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.80 / $36.10 / $36.10
| Professional | | $18.80 | $36.10 | $36.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.58 / $51.86 / $56.36
| Facility | | $24.58 | $51.86 | $56.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.02 / $33.02 / $34.38
| Professional | | $33.02 | $33.02 | $34.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.01 / $43.10 / $116.86
| Facility | | $17.01 | $43.10 | $116.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $19.97 / $62.98
| Professional | | $13.06 | $19.97 | $62.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.60 / $25.03 / $57.91
| Professional | | $12.60 | $25.03 | $57.91 |