- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.54 / $154.04 / $162.35
| Facility | | $12.54 | $154.04 | $162.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.54 / $15.29 / $19.71
| Professional | | $12.54 | $15.29 | $19.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.08 / $36.11 / $40.52
| Professional | | $27.08 | $36.11 | $40.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.65 / $20.86 / $26.23
| Professional | | $20.65 | $20.86 | $26.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.72 / $33.83 / $171.39
| Facility | | $12.72 | $33.83 | $171.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.96 / $21.50 / $35.84
| Professional | | $8.96 | $21.50 | $35.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.53 / $17.92 / $28.93
| Professional | | $7.53 | $17.92 | $28.93 |