- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.70 / $27.20 / $68.58
| Facility | | $14.70 | $27.20 | $68.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.70 / $16.67 / $29.40
| Professional | | $14.70 | $16.67 | $29.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.78 / $21.77 / $26.73
| Professional | | $10.78 | $21.77 | $26.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.56 / $42.35 / $75.63
| Facility | | $13.56 | $42.35 | $75.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.94 / $15.06 / $58.62
| Professional | | $8.94 | $15.06 | $58.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.72 / $98.68 / $100.00
| Facility | | $36.72 | $98.68 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.23 / $13.47 / $27.37
| Professional | | $8.23 | $13.47 | $27.37 |