- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.58 / $155.13 / $270.06
| Facility | | $22.58 | $155.13 | $270.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $15.54 / $20.50
| Professional | | $13.55 | $15.54 | $20.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.24 / $15.68 / $49.13
| Facility | | $15.24 | $15.68 | $49.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.95 / $21.48 / $26.85
| Professional | | $20.95 | $21.48 | $26.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.82 / $20.50 / $80.23
| Facility | | $17.82 | $20.50 | $80.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.64 / $15.16 / $41.90
| Professional | | $13.64 | $15.16 | $41.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.49 / $10.54 / $10.70
| Professional | | $7.49 | $10.54 | $10.70 |