- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.50 / $128.38 / $168.32
| Facility | | $24.50 | $128.38 | $168.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.32 / $17.28 / $24.50
| Professional | | $14.32 | $17.28 | $24.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.54 / $17.01 / $53.33
| Facility | | $16.54 | $17.01 | $53.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.15 / $22.30 / $27.88
| Professional | | $12.15 | $22.30 | $27.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.35 / $22.25 / $87.08
| Facility | | $19.35 | $22.25 | $87.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.81 / $15.74 / $22.34
| Professional | | $14.81 | $15.74 | $22.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $11.07 / $11.61
| Professional | | $8.13 | $11.07 | $11.61 |