- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.48 / $81.12 / $106.35
| Facility | | $15.48 | $81.12 | $106.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.27 / $15.48 / $15.48
| Professional | | $14.27 | $15.48 | $15.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.44 / $10.74 / $33.65
| Facility | | $10.44 | $10.74 | $33.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.64 / $14.73 / $23.53
| Professional | | $7.64 | $14.73 | $23.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.22 / $14.05 / $55.00
| Facility | | $12.22 | $14.05 | $55.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.28 / $17.34 / $21.66
| Professional | | $13.28 | $17.34 | $21.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $7.27 / $7.49
| Professional | | $5.13 | $7.27 | $7.49 |