- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.53 / $41.25 / $163.88
| Facility | | $22.53 | $41.25 | $163.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.33 / $23.37 / $23.37
| Professional | | $14.33 | $23.37 | $23.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.73 / $33.57 / $36.47
| Facility | | $18.73 | $33.57 | $36.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.97 / $21.38 / $50.07
| Professional | | $14.97 | $21.38 | $50.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.52 / $62.78 / $110.36
| Facility | | $24.52 | $62.78 | $110.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.97 / $29.08 / $40.78
| Professional | | $18.97 | $29.08 | $40.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.98 / $21.00 / $37.47
| Professional | | $9.98 | $21.00 | $37.47 |