- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.85 / $130.21 / $170.72
| Facility | | $24.85 | $130.21 | $170.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.70 / $20.46 / $29.41
| Professional | | $17.70 | $20.46 | $29.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.86 / $22.48 / $70.45
| Facility | | $21.86 | $22.48 | $70.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.31 / $29.32 / $36.65
| Professional | | $12.31 | $29.32 | $36.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.57 / $29.41 / $103.56
| Facility | | $25.57 | $29.41 | $103.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.57 / $20.89 / $29.53
| Professional | | $19.57 | $20.89 | $29.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $11.60 / $15.34
| Professional | | $10.74 | $11.60 | $15.34 |