- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.94 / $30.70 / $144.78
| Facility | | $12.94 | $30.70 | $144.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $11.98 / $13.73
| Professional | | $10.30 | $11.98 | $13.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.73 / $17.54 / $47.51
| Facility | | $13.73 | $17.54 | $47.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.78 / $6.78 / $13.52
| Professional | | $6.78 | $6.78 | $13.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.83 / $22.63 / $46.43
| Facility | | $9.83 | $22.63 | $46.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.65 / $15.69 / $20.00
| Professional | | $8.65 | $15.69 | $20.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.36 / $13.73 / $16.48
| Facility | | $12.36 | $13.73 | $16.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $8.24 / $20.60
| Professional | | $5.77 | $8.24 | $20.60 |