- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.22 / $93.37 / $173.26
| Facility | | $25.22 | $93.37 | $173.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.96 / $22.52 / $32.78
| Professional | | $17.96 | $22.52 | $32.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.37 / $25.06 / $78.55
| Facility | | $24.37 | $25.06 | $78.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.47 / $32.63 / $40.78
| Professional | | $12.47 | $32.63 | $40.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.50 / $32.78 / $115.43
| Facility | | $28.50 | $32.78 | $115.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.82 / $23.33 / $32.72
| Professional | | $21.82 | $23.33 | $32.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.84 / $11.97 / $17.10
| Professional | | $11.84 | $11.97 | $17.10 |