- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.44 / $41.07 / $105.17
| Facility | | $22.44 | $41.07 | $105.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.28 / $15.00 / $15.00
| Professional | | $14.28 | $15.00 | $15.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.66 / $21.54 / $27.80
| Facility | | $18.66 | $21.54 | $27.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.66 / $13.72 / $22.84
| Professional | | $11.66 | $13.72 | $22.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.71 / $48.54 / $57.51
| Facility | | $32.71 | $48.54 | $57.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $19.13 / $23.91
| Professional | | $10.54 | $19.13 | $23.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.40 / $10.97 / $27.12
| Professional | | $6.40 | $10.97 | $27.12 |