- 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
- $14.62 / $16.29 / $22.87
| Professional | | $14.62 | $16.29 | $22.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.88 / $17.37 / $54.43
| Facility | | $16.88 | $17.37 | $54.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.38 / $22.72 / $28.39
| Professional | | $11.38 | $22.72 | $28.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.75 / $22.71 / $81.23
| Facility | | $19.75 | $22.71 | $81.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.12 / $16.01 / $22.74
| Professional | | $15.12 | $16.01 | $22.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.30 / $10.67 / $11.85
| Professional | | $8.30 | $10.67 | $11.85 |