- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.10 / $61.42 / $151.83
| Facility | | $22.10 | $61.42 | $151.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $15.32 / $22.10
| Professional | | $13.05 | $15.32 | $22.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.07 / $15.50 / $48.58
| Facility | | $15.07 | $15.50 | $48.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $20.65 / $25.81
| Professional | | $11.06 | $20.65 | $25.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.63 / $20.27 / $79.34
| Facility | | $17.63 | $20.27 | $79.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $14.38 / $20.35
| Professional | | $13.49 | $14.38 | $20.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.40 / $7.40 / $10.58
| Professional | | $7.40 | $7.40 | $10.58 |