- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $118.34 / $261.25
| Facility | | $12.88 | $118.34 | $261.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $11.68 / $23.02
| Professional | | $10.30 | $11.68 | $23.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.09 / $22.09 / $26.51
| Facility | | $22.09 | $22.09 | $26.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.10 / $20.00 / $41.00
| Professional | | $16.10 | $20.00 | $41.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.82 / $25.82 / $25.82
| Facility | | $25.82 | $25.82 | $25.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.90 / $14.87 / $18.59
| Professional | | $7.90 | $14.87 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.41 / $7.44 / $18.00
| Professional | | $5.41 | $7.44 | $18.00 |