- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.47 / $105.75 / $124.83
| Facility | | $89.47 | $105.75 | $124.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.03 / $16.86 / $25.23
| Professional | | $14.03 | $16.86 | $25.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.65 / $38.20 / $42.87
| Professional | | $28.65 | $38.20 | $42.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.89 / $22.11 / $27.80
| Professional | | $21.89 | $22.11 | $27.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.46 / $29.49 / $120.44
| Facility | | $13.46 | $29.49 | $120.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.40 / $22.75 / $32.51
| Professional | | $9.40 | $22.75 | $32.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.96 / $22.75 / $32.51
| Professional | | $7.96 | $22.75 | $32.51 |