- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.07 / $119.66 / $267.44
| Facility | | $34.07 | $119.66 | $267.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $18.73 / $22.89
| Professional | | $17.05 | $18.73 | $22.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.51 / $25.60 / $28.32
| Facility | | $24.51 | $25.60 | $28.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $15.61 / $38.32
| Professional | | $15.61 | $15.61 | $38.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.51 / $49.69 / $87.34
| Facility | | $19.51 | $49.69 | $87.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.03 / $23.01 / $29.94
| Professional | | $15.03 | $23.01 | $29.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.74 / $17.44 / $41.18
| Professional | | $8.74 | $17.44 | $41.18 |