- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.78 / $71.45 / $121.66
| Facility | | $59.78 | $71.45 | $121.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.24 / $11.93 / $23.68
| Professional | | $11.24 | $11.93 | $23.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.93 / $26.68 / $29.79
| Professional | | $19.93 | $26.68 | $29.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.28 / $15.43 / $19.41
| Professional | | $15.28 | $15.43 | $19.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.88 / $35.49 / $80.00
| Facility | | $10.88 | $35.49 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.62 / $9.26 / $22.70
| Professional | | $6.62 | $9.26 | $22.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $13.50 / $22.70
| Professional | | $5.56 | $13.50 | $22.70 |