- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.39 / $76.63 / $162.85
| Facility | | $36.39 | $76.63 | $162.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.04 / $15.04 / $15.64
| Professional | | $15.04 | $15.04 | $15.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.05 / $26.67 / $112.36
| Professional | | $18.05 | $26.67 | $112.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.58 / $33.88 / $72.61
| Facility | | $32.58 | $33.88 | $72.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.97 / $24.28 / $156.38
| Professional | | $14.97 | $24.28 | $156.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.06 / $40.76 / $40.76
| Professional | | $23.06 | $40.76 | $40.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.42 / $12.03 / $43.50
| Professional | | $8.42 | $12.03 | $43.50 |