- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.37 / $106.65 / $209.33
| Facility | | $20.37 | $106.65 | $209.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.78 / $20.45 / $20.81
| Professional | | $16.78 | $20.45 | $20.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.57 / $21.18 / $34.00
| Professional | | $18.57 | $21.18 | $34.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.16 / $15.89 / $29.69
| Facility | | $12.16 | $15.89 | $29.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.16 / $24.38 / $37.44
| Professional | | $12.16 | $24.38 | $37.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.94 / $28.68 / $34.40
| Professional | | $22.94 | $28.68 | $34.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.32 / $13.65 / $19.37
| Professional | | $10.32 | $13.65 | $19.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.94 / $11.47 / $22.51
| Professional | | $8.94 | $11.47 | $22.51 |