- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.17 / $141.18 / $256.88
| Facility | | $37.17 | $141.18 | $256.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.01 / $25.58 / $33.75
| Professional | | $22.01 | $25.58 | $33.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.09 / $25.81 / $80.88
| Facility | | $25.09 | $25.81 | $80.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.63 / $33.86 / $42.33
| Professional | | $28.63 | $33.86 | $42.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.35 / $33.75 / $132.07
| Facility | | $29.35 | $33.75 | $132.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.46 / $24.96 / $55.06
| Professional | | $22.46 | $24.96 | $55.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.33 / $17.35 / $17.61
| Professional | | $12.33 | $17.35 | $17.61 |