- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.57 / $113.03 / $148.19
| Facility | | $21.57 | $113.03 | $148.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.60 / $14.48 / $21.57
| Professional | | $12.60 | $14.48 | $21.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.56 / $14.97 / $46.93
| Facility | | $14.56 | $14.97 | $46.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.45 / $21.48 / $26.85
| Professional | | $20.45 | $21.48 | $26.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.03 / $19.57 / $76.63
| Facility | | $17.03 | $19.57 | $76.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.03 / $14.48 / $40.70
| Professional | | $13.03 | $14.48 | $40.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.15 / $10.07 / $10.22
| Professional | | $7.15 | $10.07 | $10.22 |