- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.44 / $41.07 / $112.53
| Facility | | $22.44 | $41.07 | $112.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.26 / $15.26 / $15.26
| Professional | | $15.26 | $15.26 | $15.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.66 / $23.05 / $27.80
| Facility | | $18.66 | $23.05 | $27.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.48 / $14.68 / $22.84
| Professional | | $12.48 | $14.68 | $22.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.71 / $51.94 / $57.51
| Facility | | $32.71 | $51.94 | $57.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $20.63 / $25.78
| Professional | | $10.54 | $20.63 | $25.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.85 / $11.58 / $27.12
| Professional | | $6.85 | $11.58 | $27.12 |