- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.31 / $148.34 / $194.49
| Facility | | $28.31 | $148.34 | $194.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.12 / $19.66 / $28.31
| Professional | | $17.12 | $19.66 | $28.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.76 / $20.32 / $63.71
| Facility | | $19.76 | $20.32 | $63.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.89 / $26.85 / $33.56
| Professional | | $23.89 | $26.85 | $33.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.13 / $26.60 / $100.64
| Facility | | $23.13 | $26.60 | $100.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.70 / $19.67 / $47.88
| Professional | | $17.70 | $19.67 | $47.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.71 / $13.30 / $13.88
| Professional | | $9.71 | $13.30 | $13.88 |