- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.07 / $62.37 / $103.85
| Facility | | $34.07 | $62.37 | $103.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.81 / $14.81 / $21.67
| Professional | | $14.81 | $14.81 | $21.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.27 / $22.21 / $28.32
| Facility | | $21.27 | $22.21 | $28.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $13.55 / $39.61
| Professional | | $13.55 | $13.55 | $39.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.51 / $49.69 / $87.34
| Facility | | $19.51 | $49.69 | $87.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.03 / $20.65 / $25.81
| Professional | | $15.03 | $20.65 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.15 / $12.76 / $29.07
| Professional | | $3.15 | $12.76 | $29.07 |