- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.87 / $119.84 / $157.12
| Facility | | $22.87 | $119.84 | $157.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $15.35 / $22.87
| Professional | | $13.36 | $15.35 | $22.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.44 / $15.88 / $49.77
| Facility | | $15.44 | $15.88 | $49.77 |
- 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 / $20.77 / $81.23
| Facility | | $18.05 | $20.77 | $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
- $7.59 / $10.67 / $10.84
| Professional | | $7.59 | $10.67 | $10.84 |