- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.76 / $108.78 / $142.62
| Facility | | $20.76 | $108.78 | $142.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.12 / $13.92 / $20.76
| Professional | | $12.12 | $13.92 | $20.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.00 / $14.40 / $45.15
| Facility | | $14.00 | $14.40 | $45.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.28 / $19.00 / $23.75
| Professional | | $10.28 | $19.00 | $23.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.38 / $18.84 / $73.70
| Facility | | $16.38 | $18.84 | $73.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.54 / $13.29 / $18.75
| Professional | | $12.54 | $13.29 | $18.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.88 / $6.88 / $9.83
| Professional | | $6.88 | $6.88 | $9.83 |