- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.90 / $97.84 / $141.78
| Facility | | $91.90 | $97.84 | $141.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.86 / $17.05 / $39.13
| Professional | | $11.86 | $17.05 | $39.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $18.20 / $23.82
| Professional | | $18.20 | $18.20 | $23.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.38 / $16.14 / $55.53
| Professional | | $12.38 | $16.14 | $55.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.75 / $28.44 / $41.57
| Professional | | $22.75 | $28.44 | $41.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.01 / $12.29 / $19.80
| Professional | | $10.01 | $12.29 | $19.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.38 / $19.68 / $19.68
| Professional | | $11.38 | $19.68 | $19.68 |