- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.53 / $83.88 / $153.77
| Facility | | $24.53 | $83.88 | $153.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $10.14 / $10.14
| Professional | | $10.14 | $10.14 | $10.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.85 / $46.20 / $135.22
| Professional | | $10.85 | $46.20 | $135.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.98 / $22.85 / $48.80
| Facility | | $21.98 | $22.85 | $48.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $15.69 / $19.62
| Professional | | $7.46 | $15.69 | $19.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.48 / $27.48 / $27.48
| Professional | | $27.48 | $27.48 | $27.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.68 / $8.11 / $12.30
| Professional | | $5.68 | $8.11 | $12.30 |