- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.60 / $50.34 / $179.52
| Facility | | $39.60 | $50.34 | $179.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.52 / $10.58 / $14.39
| Professional | | $9.52 | $10.58 | $14.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.01 / $19.62 / $27.86
| Professional | | $11.01 | $19.62 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.80 / $33.28 / $38.70
| Professional | | $25.80 | $33.28 | $38.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.06 / $11.92 / $16.53
| Professional | | $6.06 | $11.92 | $16.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.37 / $4.46 / $5.61
| Professional | | $4.37 | $4.46 | $5.61 |