- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.52 / $140.32 / $150.47
| Facility | | $10.52 | $140.32 | $150.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $26.04 / $27.24
| Professional | | $14.13 | $26.04 | $27.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.71 / $30.29 / $33.99
| Professional | | $22.71 | $30.29 | $33.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $17.10 / $21.50
| Professional | | $16.93 | $17.10 | $21.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.52 / $22.55 / $142.80
| Facility | | $10.52 | $22.55 | $142.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $18.04 / $25.78
| Professional | | $7.46 | $18.04 | $25.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $10.52 / $25.78
| Professional | | $6.31 | $10.52 | $25.78 |