- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.22 / $174.03 / $227.57
| Facility | | $158.22 | $174.03 | $227.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.13 / $12.65 / $19.69
| Professional | | $11.13 | $12.65 | $19.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.66 / $15.57 / $25.16
| Professional | | $13.66 | $15.57 | $25.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.94 / $11.68 / $21.83
| Facility | | $8.94 | $11.68 | $21.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.94 / $17.92 / $27.43
| Professional | | $8.94 | $17.92 | $27.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.03 / $20.23 / $25.31
| Professional | | $16.03 | $20.23 | $25.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.85 / $9.90 / $12.82
| Professional | | $5.85 | $9.90 | $12.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.58 / $8.44 / $16.55
| Professional | | $6.58 | $8.44 | $16.55 |