- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.04 / $83.39 / $111.27
| Facility | | $34.04 | $83.39 | $111.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.04 / $13.38 / $20.37
| Professional | | $12.04 | $13.38 | $20.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.83 / $16.28 / $51.04
| Facility | | $15.83 | $16.28 | $51.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.57 / $21.06 / $26.33
| Professional | | $8.57 | $21.06 | $26.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.52 / $21.30 / $75.01
| Facility | | $18.52 | $21.30 | $75.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.18 / $15.19 / $21.55
| Professional | | $14.18 | $15.19 | $21.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.78 / $8.02 / $11.11
| Professional | | $7.78 | $8.02 | $11.11 |