- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.36 / $71.17 / $115.25
| Facility | | $10.36 | $71.17 | $115.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.36 / $13.04 / $17.30
| Professional | | $10.36 | $13.04 | $17.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.86 / $13.23 / $41.46
| Facility | | $12.86 | $13.23 | $41.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.51 / $17.35 / $21.68
| Professional | | $9.51 | $17.35 | $21.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.05 / $17.30 / $67.76
| Facility | | $15.05 | $17.30 | $67.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.52 / $12.21 / $17.16
| Professional | | $11.52 | $12.21 | $17.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.32 / $8.61 / $9.02
| Professional | | $6.32 | $8.61 | $9.02 |