- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $63.10 / $104.71
| Facility | | $37.15 | $63.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $8.71 / $51.29
| Professional | | $6.76 | $8.71 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $19.50 / $21.88
| Professional | | $12.88 | $19.50 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $14.13
| Professional | | $11.22 | $11.22 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.45 / $53.70 / $102.33
| Facility | | $14.45 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.90 / $13.49 / $35.48
| Professional | | $4.90 | $13.49 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $10.00 / $16.60
| Professional | | $4.79 | $10.00 | $16.60 |