- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.86 / $107.33 / $157.05
| Facility | | $22.86 | $107.33 | $157.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $15.63 / $22.86
| Professional | | $13.36 | $15.63 | $22.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.42 / $15.86 / $49.72
| Facility | | $15.42 | $15.86 | $49.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.38 / $20.65 / $25.81
| Professional | | $11.38 | $20.65 | $25.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.05 / $20.76 / $81.23
| Facility | | $18.05 | $20.76 | $81.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.82 / $14.65 / $20.75
| Professional | | $13.82 | $14.65 | $20.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.58 / $10.40 / $10.83
| Professional | | $7.58 | $10.40 | $10.83 |