- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.52 / $77.87 / $108.49
| Facility | | $27.52 | $77.87 | $108.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.01 / $13.76 / $14.37
| Professional | | $13.01 | $13.76 | $14.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.02 / $30.81 / $34.40
| Professional | | $23.02 | $30.81 | $34.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $17.52 / $22.03
| Professional | | $17.35 | $17.52 | $22.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.70 / $22.94 / $55.19
| Facility | | $10.70 | $22.94 | $55.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.58 / $18.35 / $25.99
| Professional | | $7.58 | $18.35 | $25.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.42 / $10.00 / $24.50
| Professional | | $6.42 | $10.00 | $24.50 |