- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.06 / $142.27 / $199.64
| Facility | | $29.06 | $142.27 | $199.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $20.50 / $29.06
| Professional | | $16.98 | $20.50 | $29.06 |
- 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 / $13.22 / $13.76
| Professional | | $9.63 | $13.22 | $13.76 |