- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.48 / $35.84 / $209.91
| Facility | | $30.48 | $35.84 | $209.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.97 / $25.77 / $30.48
| Professional | | $13.97 | $25.77 | $30.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.34 / $22.34 / $22.34
| Facility | | $22.34 | $22.34 | $22.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.21 / $32.65 / $32.65
| Professional | | $22.21 | $32.65 | $32.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.78 / $24.19 / $49.66
| Facility | | $14.78 | $24.19 | $49.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.62 / $22.72 / $28.39
| Professional | | $11.62 | $22.72 | $28.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.23 / $13.69 / $27.37
| Professional | | $8.23 | $13.69 | $27.37 |