- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.55 / $174.81 / $241.30
| Facility | | $11.55 | $174.81 | $241.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $10.46 / $11.55
| Professional | | $10.46 | $10.46 | $11.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.80 / $19.80 / $23.76
| Facility | | $19.80 | $19.80 | $23.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.44 / $18.00 / $37.00
| Professional | | $14.44 | $18.00 | $37.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.03 / $23.03 / $23.03
| Facility | | $23.03 | $23.03 | $23.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.14 / $13.22 / $16.52
| Professional | | $7.14 | $13.22 | $16.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $6.67 / $16.13
| Professional | | $4.84 | $6.67 | $16.13 |