- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.06 / $115.75 / $231.50
| Facility | | $29.06 | $115.75 | $231.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.21 / $20.45 / $26.38
| Professional | | $17.21 | $20.45 | $26.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.61 / $20.17 / $63.20
| Facility | | $19.61 | $20.17 | $63.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.49 / $26.43 / $33.04
| Professional | | $14.49 | $26.43 | $33.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.94 / $26.38 / $103.23
| Facility | | $22.94 | $26.38 | $103.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $18.72 / $26.33
| Professional | | $17.55 | $18.72 | $26.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.63 / $13.56 / $13.76
| Professional | | $9.63 | $13.56 | $13.76 |