- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.74 / $15.74 / $40.46
| Facility | | $15.74 | $15.74 | $40.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.74 / $21.13 / $102.20
| Professional | | $15.74 | $21.13 | $102.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.36 / $45.30 / $50.83
| Professional | | $37.36 | $45.30 | $50.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.61 / $25.86 / $32.52
| Professional | | $25.61 | $25.86 | $32.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.74 / $26.76 / $106.78
| Facility | | $15.74 | $26.76 | $106.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.24 / $18.13 / $38.22
| Professional | | $11.24 | $18.13 | $38.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.24 / $18.13 / $32.60
| Professional | | $11.24 | $18.13 | $32.60 |