- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.27 / $73.88 / $111.83
| Facility | | $22.27 | $73.88 | $111.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $12.05 / $12.05
| Professional | | $12.05 | $12.05 | $12.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.85 / $70.23 / $160.63
| Professional | | $12.85 | $70.23 | $160.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.10 / $27.14 / $58.33
| Facility | | $26.10 | $27.14 | $58.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.80 / $18.59 / $23.23
| Professional | | $8.80 | $18.59 | $23.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.65 / $32.65 / $32.65
| Professional | | $32.65 | $32.65 | $32.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $9.85 / $14.61
| Professional | | $9.42 | $9.85 | $14.61 |