- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.52 / $80.37 / $165.31
| Facility | | $79.52 | $80.37 | $165.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.88 / $14.00 / $22.76
| Professional | | $11.88 | $14.00 | $22.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.27 / $32.36 / $36.32
| Professional | | $24.27 | $32.36 | $36.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.59 / $18.77 / $23.60
| Professional | | $18.59 | $18.77 | $23.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.40 / $33.72 / $124.96
| Facility | | $11.40 | $33.72 | $124.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.02 / $19.27 / $32.11
| Professional | | $8.02 | $19.27 | $32.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $11.24 / $27.54
| Professional | | $6.75 | $11.24 | $27.54 |