- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.93 / $90.17 / $134.10
| Facility | | $70.93 | $90.17 | $134.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $13.15 / $24.64
| Professional | | $10.56 | $13.15 | $24.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.07 / $30.39 / $34.10
| Professional | | $25.07 | $30.39 | $34.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $17.52 / $22.03
| Professional | | $17.35 | $17.52 | $22.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.08 / $68.26 / $121.50
| Facility | | $15.08 | $68.26 | $121.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.54 / $10.55 / $30.16
| Professional | | $7.54 | $10.55 | $30.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.33 / $15.38 / $25.85
| Professional | | $6.33 | $15.38 | $25.85 |