- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.27 / $87.00 / $102.80
| Facility | | $18.27 | $87.00 | $102.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.25 / $9.65 / $9.72
| Professional | | $8.25 | $9.65 | $9.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.14 / $13.73 / $22.63
| Facility | | $13.14 | $13.73 | $22.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.86 / $8.36 / $21.26
| Professional | | $5.86 | $8.36 | $21.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.51 / $26.64 / $46.82
| Facility | | $10.51 | $26.64 | $46.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.05 / $12.34 / $16.52
| Professional | | $8.05 | $12.34 | $16.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.91 / $8.15 / $17.86
| Professional | | $3.91 | $8.15 | $17.86 |