- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.96 / $53.02 / $101.72
| Facility | | $28.96 | $53.02 | $101.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.51 / $14.51 / $18.43
| Professional | | $14.51 | $14.51 | $18.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.84 / $21.76 / $35.88
| Facility | | $20.84 | $21.76 | $35.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.28 / $13.27 / $33.68
| Professional | | $9.28 | $13.27 | $33.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.51 / $42.24 / $74.26
| Facility | | $16.51 | $42.24 | $74.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.71 / $19.57 / $25.81
| Professional | | $12.71 | $19.57 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.43 / $17.44 / $28.30
| Professional | | $7.43 | $17.44 | $28.30 |