- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.16 / $105.64 / $138.50
| Facility | | $20.16 | $105.64 | $138.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.84 / $18.09 / $23.06
| Professional | | $14.84 | $18.09 | $23.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.13 / $17.62 / $55.23
| Facility | | $17.13 | $17.62 | $55.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.62 / $23.13 / $38.29
| Professional | | $12.62 | $23.13 | $38.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.05 / $23.06 / $90.23
| Facility | | $20.05 | $23.06 | $90.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $23.94 / $27.66
| Professional | | $17.05 | $23.94 | $27.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.42 / $11.93 / $12.03
| Professional | | $8.42 | $11.93 | $12.03 |