- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.36 / $135.40 / $228.38
| Facility | | $50.36 | $135.40 | $228.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.76 / $14.39 / $18.48
| Professional | | $11.76 | $14.39 | $18.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.79 / $20.66 / $34.08
| Facility | | $19.79 | $20.66 | $34.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.82 / $12.60 / $32.00
| Professional | | $8.82 | $12.60 | $32.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.76 / $40.10 / $70.50
| Facility | | $15.76 | $40.10 | $70.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.17 / $18.57 / $24.26
| Professional | | $12.17 | $18.57 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.06 / $11.74 / $26.88
| Professional | | $7.06 | $11.74 | $26.88 |