- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.32 / $106.68 / $139.60
| Facility | | $20.32 | $106.68 | $139.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $20.32 / $42.99
| Professional | | $12.05 | $20.32 | $42.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.74 / $14.13 / $44.30
| Facility | | $13.74 | $14.13 | $44.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.13 / $18.59 / $23.23
| Professional | | $10.13 | $18.59 | $23.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.07 / $18.48 / $72.29
| Facility | | $16.07 | $18.48 | $72.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $13.02 / $18.35
| Professional | | $12.30 | $13.02 | $18.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $9.50 / $9.64
| Professional | | $6.75 | $9.50 | $9.64 |