- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.09 / $47.86 / $124.38
| Facility | | $35.09 | $47.86 | $124.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.82 / $40.35 / $46.17
| Professional | | $31.82 | $40.35 | $46.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.58 / $44.39 / $59.72
| Facility | | $36.58 | $44.39 | $59.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.66 / $23.01 / $27.15
| Professional | | $15.66 | $23.01 | $27.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.45 / $36.95 / $109.88
| Facility | | $27.45 | $36.95 | $109.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.48 / $21.84 / $196.49
| Professional | | $15.48 | $21.84 | $196.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.74 / $14.74 / $39.36
| Professional | | $14.74 | $14.74 | $39.36 |