- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.43 / $53.88 / $228.60
| Facility | | $29.43 | $53.88 | $228.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.02 / $16.05 / $17.98
| Professional | | $14.02 | $16.05 | $17.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.18 / $22.12 / $24.46
| Facility | | $21.18 | $22.12 | $24.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $34.21
| Professional | | $13.49 | $13.49 | $34.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.52 / $42.91 / $75.44
| Facility | | $17.52 | $42.91 | $75.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $20.65 / $25.81
| Professional | | $13.06 | $20.65 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.29 / $13.12 / $35.57
| Professional | | $6.29 | $13.12 | $35.57 |