- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.54 / $134.04 / $143.13
| Facility | | $33.54 | $134.04 | $143.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.20 / $13.38 / $17.42
| Professional | | $12.20 | $13.38 | $17.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.17 / $37.56 / $42.15
| Professional | | $28.17 | $37.56 | $42.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.48 / $21.69 / $27.27
| Professional | | $21.48 | $21.69 | $27.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.05 / $27.96 / $104.01
| Facility | | $13.05 | $27.96 | $104.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $18.64 / $31.69
| Professional | | $7.83 | $18.64 | $31.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $9.51 / $27.03
| Professional | | $7.83 | $9.51 | $27.03 |