- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.21 / $83.64 / $156.65
| Facility | | $23.21 | $83.64 | $156.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $12.67 / $14.18
| Professional | | $11.06 | $12.67 | $14.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.70 / $17.44 / $28.75
| Facility | | $16.70 | $17.44 | $28.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.45 / $10.64 / $27.00
| Professional | | $7.45 | $10.64 | $27.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.26 / $33.84 / $59.48
| Facility | | $13.26 | $33.84 | $59.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $15.68 / $20.65
| Professional | | $10.19 | $15.68 | $20.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.96 / $11.89 / $22.69
| Professional | | $5.96 | $11.89 | $22.69 |