- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.36 / $135.56 / $237.60
| Facility | | $25.36 | $135.56 | $237.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.30 / $27.00 / $28.10
| Professional | | $13.30 | $27.00 | $28.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.23 / $19.05 / $31.42
| Facility | | $18.23 | $19.05 | $31.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.62 / $11.62 / $29.49
| Professional | | $11.62 | $11.62 | $29.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.51 / $36.97 / $64.98
| Facility | | $14.51 | $36.97 | $64.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.27 / $17.12 / $22.20
| Professional | | $11.27 | $17.12 | $22.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.51 / $12.98 / $30.65
| Professional | | $6.51 | $12.98 | $30.65 |