- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.93 / $86.48 / $157.72
| Facility | | $26.93 | $86.48 | $157.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.34 / $14.92 / $21.21
| Professional | | $14.34 | $14.92 | $21.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $24.98 / $33.36
| Facility | | $22.39 | $24.98 | $33.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.91 / $15.91 / $31.33
| Professional | | $15.91 | $15.91 | $31.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.51 / $39.27 / $69.04
| Facility | | $15.51 | $39.27 | $69.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.81 / $18.20 / $30.46
| Professional | | $11.81 | $18.20 | $30.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $13.80 / $32.54
| Professional | | $8.91 | $13.80 | $32.54 |