- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.68 / $98.20 / $152.05
| Facility | | $56.68 | $98.20 | $152.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.44 / $10.22 / $11.43
| Professional | | $8.44 | $10.22 | $11.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.21 / $23.03 / $25.72
| Professional | | $17.21 | $23.03 | $25.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.22 / $13.35 / $16.78
| Professional | | $13.22 | $13.35 | $16.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.11 / $24.00 / $58.59
| Facility | | $8.11 | $24.00 | $58.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.72 / $13.72 / $22.86
| Professional | | $5.72 | $13.72 | $22.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.80 / $8.00 / $19.60
| Professional | | $4.80 | $8.00 | $19.60 |