- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.44 / $80.38 / $186.49
| Facility | | $63.44 | $80.38 | $186.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.27 / $25.03 / $29.79
| Professional | | $18.27 | $25.03 | $29.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.03 / $24.71 / $77.45
| Facility | | $24.03 | $24.71 | $77.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.76 / $32.21 / $40.27
| Professional | | $17.76 | $32.21 | $40.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.10 / $32.32 / $126.44
| Facility | | $28.10 | $32.32 | $126.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.51 / $22.79 / $32.32
| Professional | | $21.51 | $22.79 | $32.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.80 / $16.72 / $16.86
| Professional | | $11.80 | $16.72 | $16.86 |