- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.73 / $76.62 / $211.80
| Facility | | $57.73 | $76.62 | $211.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.68 / $10.99 / $57.85
| Professional | | $8.68 | $10.99 | $57.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.42 / $23.31 / $26.03
| Professional | | $17.42 | $23.31 | $26.03 |
- 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
- $11.75 / $64.64 / $107.52
| Facility | | $11.75 | $64.64 | $107.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.30 / $13.88 / $19.67
| Professional | | $5.30 | $13.88 | $19.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.86 / $11.80 / $18.30
| Professional | | $4.86 | $11.80 | $18.30 |