- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.48 / $73.63 / $103.06
| Facility | | $24.48 | $73.63 | $103.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $12.67 / $14.18
| Professional | | $10.48 | $12.67 | $14.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.12 / $12.47 / $39.08
| Facility | | $12.12 | $12.47 | $39.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.88 / $16.52 / $20.65
| Professional | | $8.88 | $16.52 | $20.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.18 / $16.30 / $63.79
| Facility | | $14.18 | $16.30 | $63.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.85 / $11.67 / $16.36
| Professional | | $10.85 | $11.67 | $16.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.96 / $8.38 / $8.51
| Professional | | $5.96 | $8.38 | $8.51 |