- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.16 / $102.01 / $138.50
| Facility | | $20.16 | $102.01 | $138.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.16 / $20.16 / $23.98
| Professional | | $20.16 | $20.16 | $23.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.97 / $23.63 / $74.06
| Facility | | $22.97 | $23.63 | $74.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.62 / $28.39 / $49.13
| Professional | | $12.62 | $28.39 | $49.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.88 / $30.91 / $108.86
| Facility | | $26.88 | $30.91 | $108.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.59 / $28.43 / $32.32
| Professional | | $22.59 | $28.43 | $32.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.29 / $12.29 / $16.13
| Professional | | $11.29 | $12.29 | $16.13 |