- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.35 / $106.63 / $139.81
| Facility | | $20.35 | $106.63 | $139.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.41 / $17.21 / $25.05
| Professional | | $14.41 | $17.21 | $25.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $19.14 / $60.02
| Facility | | $18.62 | $19.14 | $60.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.13 / $24.78 / $30.98
| Professional | | $10.13 | $24.78 | $30.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.78 / $25.05 / $88.21
| Facility | | $21.78 | $25.05 | $88.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.67 / $17.64 / $25.14
| Professional | | $16.67 | $17.64 | $25.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.15 / $9.15 / $13.07
| Professional | | $9.15 | $9.15 | $13.07 |