- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.41 / $106.95 / $140.22
| Facility | | $20.41 | $106.95 | $140.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.94 / $13.71 / $20.41
| Professional | | $11.94 | $13.71 | $20.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.78 / $14.17 / $44.42
| Facility | | $13.78 | $14.17 | $44.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.13 / $18.59 / $23.23
| Professional | | $10.13 | $18.59 | $23.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.13 / $18.55 / $72.58
| Facility | | $16.13 | $18.55 | $72.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.35 / $13.02 / $18.75
| Professional | | $12.35 | $13.02 | $18.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.77 / $6.77 / $9.68
| Professional | | $6.77 | $6.77 | $9.68 |