- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.63 / $71.93 / $209.82
| Facility | | $30.63 | $71.93 | $209.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $21.61 / $27.81
| Professional | | $17.89 | $21.61 | $27.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.67 / $21.26 / $66.64
| Facility | | $20.67 | $21.26 | $66.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.27 / $28.08 / $35.11
| Professional | | $15.27 | $28.08 | $35.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.18 / $27.81 / $108.82
| Facility | | $24.18 | $27.81 | $108.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.51 / $19.80 / $27.93
| Professional | | $18.51 | $19.80 | $27.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $14.29 / $14.51
| Professional | | $10.16 | $14.29 | $14.51 |