- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $177.83 / $177.83
| Facility | | $39.81 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $10.47 / $12.30
| Professional | | $3.39 | $10.47 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $15.85 / $123.03
| Professional | | $10.96 | $15.85 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $29.51 / $38.90
| Professional | | $25.70 | $29.51 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.48 / $15.49 / $18.20
| Facility | | $11.48 | $15.49 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $12.02 / $17.78
| Professional | | $7.59 | $12.02 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.37 / $5.62 / $11.22
| Professional | | $4.37 | $5.62 | $11.22 |