- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.26 / $49.10 / $155.50
| Facility | | $13.26 | $49.10 | $155.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.86 / $10.71 / $13.78
| Professional | | $8.86 | $10.71 | $13.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.24 / $10.54 / $33.02
| Facility | | $10.24 | $10.54 | $33.02 |
- 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
- $11.98 / $13.78 / $53.91
| Facility | | $11.98 | $13.78 | $53.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.17 / $9.76 / $13.96
| Professional | | $9.17 | $9.76 | $13.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.03 / $5.03 / $7.19
| Professional | | $5.03 | $5.03 | $7.19 |