- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.37 / $69.64 / $84.58
| Facility | | $10.37 | $69.64 | $84.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.37 / $10.37 / $10.37
| Professional | | $10.37 | $10.37 | $10.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $48.17 / $120.01
| Professional | | $11.06 | $48.17 | $120.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.45 / $23.35 / $50.00
| Facility | | $22.45 | $23.35 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.65 / $16.11 / $20.13
| Professional | | $7.65 | $16.11 | $20.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.09 / $28.09 / $28.09
| Professional | | $28.09 | $28.09 | $28.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $7.60 / $18.78
| Professional | | $6.46 | $7.60 | $18.78 |