- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.41 / $95.92 / $214.72
| Facility | | $20.41 | $95.92 | $214.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.13 / $13.55 / $26.00
| Professional | | $11.13 | $13.55 | $26.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.05 / $16.63 / $52.07
| Facility | | $15.05 | $16.63 | $52.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.22 / $7.44 / $16.83
| Professional | | $7.22 | $7.44 | $16.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.52 / $25.18 / $51.47
| Facility | | $10.52 | $25.18 | $51.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.43 / $16.93 / $22.03
| Professional | | $9.43 | $16.93 | $22.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.58 / $22.58 / $22.58
| Facility | | $22.58 | $22.58 | $22.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $12.62 / $21.03
| Professional | | $9.02 | $12.62 | $21.03 |