- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.85 / $177.14 / $202.03
| Facility | | $40.85 | $177.14 | $202.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.53 / $11.79 / $13.63
| Professional | | $9.53 | $11.79 | $13.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $16.76 / $27.65
| Facility | | $16.05 | $16.76 | $27.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.15 / $10.22 / $25.94
| Professional | | $7.15 | $10.22 | $25.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.76 / $32.54 / $57.22
| Facility | | $12.76 | $32.54 | $57.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.84 / $15.06 / $19.62
| Professional | | $9.84 | $15.06 | $19.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.72 / $9.52 / $21.81
| Professional | | $5.72 | $9.52 | $21.81 |