- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.07 / $115.12 / $131.62
| Facility | | $34.07 | $115.12 | $131.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $18.72 / $20.81
| Professional | | $17.05 | $18.72 | $20.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.51 / $25.60 / $42.21
| Facility | | $24.51 | $25.60 | $42.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.93 / $15.61 / $39.61
| Professional | | $10.93 | $15.61 | $39.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.51 / $49.69 / $87.34
| Facility | | $19.51 | $49.69 | $87.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.03 / $23.00 / $29.94
| Professional | | $15.03 | $23.00 | $29.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.74 / $17.44 / $33.29
| Professional | | $8.74 | $17.44 | $33.29 |