- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.26 / $104.49 / $164.58
| Facility | | $42.26 | $104.49 | $164.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.78 / $23.21 / $23.38
| Professional | | $16.78 | $23.21 | $23.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.40 / $31.75 / $52.35
| Facility | | $30.40 | $31.75 | $52.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $19.36 / $49.14
| Professional | | $13.55 | $19.36 | $49.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.27 / $61.60 / $108.29
| Facility | | $24.27 | $61.60 | $108.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.61 / $28.53 / $37.17
| Professional | | $18.61 | $28.53 | $37.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $21.00 / $41.30
| Professional | | $9.02 | $21.00 | $41.30 |