- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.86 / $67.00 / $181.47
| Facility | | $54.86 | $67.00 | $181.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.38 / $13.85 / $13.96
| Professional | | $11.38 | $13.85 | $13.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.47 / $15.08 / $22.78
| Professional | | $12.47 | $15.08 | $22.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.16 / $10.66 / $19.92
| Facility | | $8.16 | $10.66 | $19.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.16 / $16.34 / $25.25
| Professional | | $8.16 | $16.34 | $25.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.39 / $19.23 / $23.09
| Professional | | $15.39 | $19.23 | $23.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $9.23 / $11.70
| Professional | | $6.46 | $9.23 | $11.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $7.70 / $15.11
| Professional | | $6.00 | $7.70 | $15.11 |