- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.76 / $66.34 / $162.76
| Facility | | $23.76 | $66.34 | $162.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.06 / $16.11 / $22.44
| Professional | | $14.06 | $16.11 | $22.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.03 / $16.48 / $51.67
| Facility | | $16.03 | $16.48 | $51.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.84 / $21.48 / $26.85
| Professional | | $11.84 | $21.48 | $26.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.75 / $21.56 / $84.36
| Facility | | $18.75 | $21.56 | $84.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.36 / $15.19 / $21.55
| Professional | | $14.36 | $15.19 | $21.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $10.73 / $11.25
| Professional | | $7.88 | $10.73 | $11.25 |