- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.48 / $98.38 / $133.51
| Facility | | $19.48 | $98.38 | $133.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.88 / $20.54 / $24.18
| Professional | | $16.88 | $20.54 | $24.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $20.05 / $62.86
| Facility | | $19.50 | $20.05 | $62.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.34 / $26.43 / $33.04
| Professional | | $14.34 | $26.43 | $33.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.81 / $26.23 / $102.63
| Facility | | $22.81 | $26.23 | $102.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.46 / $18.72 / $26.33
| Professional | | $17.46 | $18.72 | $26.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.58 / $13.49 / $31.89
| Professional | | $9.58 | $13.49 | $31.89 |