- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.28 / $110.05 / $180.27
| Facility | | $56.28 | $110.05 | $180.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.60 / $20.94 / $24.00
| Professional | | $9.60 | $20.94 | $24.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.26 / $10.55 / $33.06
| Facility | | $10.26 | $10.55 | $33.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $13.63 / $17.04
| Professional | | $7.48 | $13.63 | $17.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.00 / $13.80 / $53.99
| Facility | | $12.00 | $13.80 | $53.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.19 / $9.76 / $13.96
| Professional | | $9.19 | $9.76 | $13.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $7.09 / $7.20
| Professional | | $5.04 | $7.09 | $7.20 |