- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.10 / $108.15 / $137.51
| Facility | | $47.10 | $108.15 | $137.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.56 / $19.32 / $23.56
| Professional | | $15.56 | $19.32 | $23.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.00 / $19.54 / $61.25
| Facility | | $19.00 | $19.54 | $61.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.02 / $25.61 / $32.01
| Professional | | $14.02 | $25.61 | $32.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.23 / $25.56 / $100.08
| Facility | | $22.23 | $25.56 | $100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $18.18 / $25.54
| Professional | | $17.02 | $18.18 | $25.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.34 / $13.14 / $13.34
| Professional | | $9.34 | $13.14 | $13.34 |