- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.79 / $108.94 / $142.83
| Facility | | $20.79 | $108.94 | $142.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.68 / $14.80 / $21.11
| Professional | | $12.68 | $14.80 | $21.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.69 / $16.14 / $50.57
| Facility | | $15.69 | $16.14 | $50.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.28 / $21.06 / $26.33
| Professional | | $10.28 | $21.06 | $26.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.36 / $21.11 / $74.36
| Facility | | $18.36 | $21.11 | $74.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.06 / $14.93 / $21.15
| Professional | | $14.06 | $14.93 | $21.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.71 / $9.69 / $11.02
| Professional | | $7.71 | $9.69 | $11.02 |