- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.45 / $82.24 / $148.57
| Facility | | $25.45 | $82.24 | $148.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.34 / $15.22 / $21.21
| Professional | | $14.34 | $15.22 | $21.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.19 / $16.97 / $24.48
| Professional | | $15.19 | $16.97 | $24.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.02 / $13.94 / $27.44
| Facility | | $11.02 | $13.94 | $27.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.02 / $17.48 / $30.46
| Professional | | $11.02 | $17.48 | $30.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.21 / $26.51 / $31.82
| Professional | | $21.21 | $26.51 | $31.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.53 / $10.61 / $19.30
| Professional | | $9.53 | $10.61 | $19.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.27 / $10.61 / $16.86
| Professional | | $8.27 | $10.61 | $16.86 |