- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.11 / $73.44 / $140.93
| Facility | | $40.11 | $73.44 | $140.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.10 / $22.04 / $22.04
| Professional | | $20.10 | $22.04 | $22.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.87 / $30.15 / $49.70
| Facility | | $28.87 | $30.15 | $49.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.87 / $18.38 / $46.64
| Professional | | $12.87 | $18.38 | $46.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.01 / $58.49 / $102.83
| Facility | | $23.01 | $58.49 | $102.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.72 / $27.09 / $35.11
| Professional | | $17.72 | $27.09 | $35.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.29 / $17.89 / $39.22
| Professional | | $10.29 | $17.89 | $39.22 |