- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.20 / $108.20 / $168.59
| Facility | | $64.20 | $108.20 | $168.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.57 / $16.77 / $23.26
| Professional | | $13.57 | $16.77 | $23.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.57 / $17.04 / $53.41
| Facility | | $16.57 | $17.04 | $53.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.15 / $22.30 / $27.88
| Professional | | $12.15 | $22.30 | $27.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.38 / $22.29 / $87.20
| Facility | | $19.38 | $22.29 | $87.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.83 / $15.74 / $22.34
| Professional | | $14.83 | $15.74 | $22.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.14 / $11.53 / $11.63
| Professional | | $8.14 | $11.53 | $11.63 |