- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.68 / $118.49 / $167.51
| Facility | | $55.68 | $118.49 | $167.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.01 / $16.59 / $20.44
| Professional | | $13.01 | $16.59 | $20.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.88 / $22.85 / $37.68
| Facility | | $21.88 | $22.85 | $37.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.76 / $13.94 / $35.36
| Professional | | $9.76 | $13.94 | $35.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.51 / $44.36 / $77.98
| Facility | | $17.51 | $44.36 | $77.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.42 / $20.55 / $26.33
| Professional | | $13.42 | $20.55 | $26.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.80 / $13.57 / $29.73
| Professional | | $7.80 | $13.57 | $29.73 |