- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.27 / $107.18 / $167.48
| Facility | | $21.27 | $107.18 | $167.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.75 / $7.75 / $7.75
| Professional | | $7.75 | $7.75 | $7.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.26 / $45.17 / $103.30
| Professional | | $8.26 | $45.17 | $103.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.78 / $17.45 / $38.09
| Facility | | $16.78 | $17.45 | $38.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.74 / $11.98 / $14.97
| Professional | | $5.74 | $11.98 | $14.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.00 / $21.00 / $21.00
| Professional | | $21.00 | $21.00 | $21.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.06 / $6.33 / $9.40
| Professional | | $6.06 | $6.33 | $9.40 |