- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.39 / $90.00 / $161.10
| Facility | | $74.39 | $90.00 | $161.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $9.07 / $12.16
| Professional | | $8.52 | $9.07 | $12.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.32 / $20.51 / $22.91
| Professional | | $15.32 | $20.51 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.56 / $11.68 / $14.69
| Professional | | $11.56 | $11.68 | $14.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.18 / $80.76 / $111.18
| Facility | | $10.18 | $80.76 | $111.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $12.22 / $20.36
| Professional | | $5.09 | $12.22 | $20.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.28 / $5.67 / $14.76
| Professional | | $4.28 | $5.67 | $14.76 |