- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.87 / $87.21 / $134.08
| Facility | | $12.87 | $87.21 | $134.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.61 / $16.55 / $20.23
| Professional | | $13.61 | $16.55 | $20.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.79 / $37.06 / $41.59
| Professional | | $27.79 | $37.06 | $41.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.06 / $21.27 / $26.75
| Professional | | $21.06 | $21.27 | $26.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.87 / $27.59 / $96.88
| Facility | | $12.87 | $27.59 | $96.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.19 / $12.87 / $31.54
| Professional | | $9.19 | $12.87 | $31.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.72 / $22.07 / $31.54
| Professional | | $7.72 | $22.07 | $31.54 |