- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.01 / $40.63 / $146.61
| Facility | | $22.01 | $40.63 | $146.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.32 / $23.02 / $30.47
| Professional | | $20.32 | $23.02 | $30.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.01 / $24.22 / $127.44
| Facility | | $17.01 | $24.22 | $127.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.09 / $41.59 / $49.83
| Professional | | $27.09 | $41.59 | $49.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.32 / $20.32 / $28.78
| Professional | | $20.32 | $20.32 | $28.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.85 / $14.22 / $74.48
| Professional | | $11.85 | $14.22 | $74.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.32 / $20.32 / $20.32
| Professional | | $20.32 | $20.32 | $20.32 |