- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.51 / $128.43 / $167.89
| Facility | | $24.51 | $128.43 | $167.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.51 / $17.25 / $24.51
| Professional | | $14.51 | $17.25 | $24.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.54 / $17.01 / $53.33
| Facility | | $16.54 | $17.01 | $53.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.15 / $22.30 / $27.88
| Professional | | $12.15 | $22.30 | $27.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.35 / $22.25 / $87.12
| Facility | | $19.35 | $22.25 | $87.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.81 / $15.74 / $22.34
| Professional | | $14.81 | $15.74 | $22.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $11.44 / $11.61
| Professional | | $8.13 | $11.44 | $11.61 |