- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.56 / $54.12 / $103.85
| Facility | | $29.56 | $54.12 | $103.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.81 / $14.81 / $18.80
| Professional | | $14.81 | $14.81 | $18.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.27 / $22.21 / $36.63
| Facility | | $21.27 | $22.21 | $36.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $13.55 / $34.38
| Professional | | $13.55 | $13.55 | $34.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.01 / $43.10 / $75.77
| Facility | | $17.01 | $43.10 | $75.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $19.97 / $25.81
| Professional | | $13.06 | $19.97 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.32 / $15.14 / $55.00
| Professional | | $6.32 | $15.14 | $55.00 |