- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.35 / $117.34 / $160.38
| Facility | | $22.35 | $117.34 | $160.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $15.88 / $22.35
| Professional | | $13.06 | $15.88 | $22.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.08 / $15.51 / $48.62
| Facility | | $15.08 | $15.51 | $48.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $20.65 / $25.81
| Professional | | $11.06 | $20.65 | $25.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.64 / $20.30 / $79.42
| Facility | | $17.64 | $20.30 | $79.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.51 / $14.38 / $20.35
| Professional | | $13.51 | $14.38 | $20.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $10.43 / $10.59
| Professional | | $7.41 | $10.43 | $10.59 |