- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.56 / $45.47 / $103.23
| Facility | | $25.56 | $45.47 | $103.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $25.56 / $31.13
| Professional | | $20.00 | $25.56 | $31.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.04 / $18.02 / $32.77
| Professional | | $17.04 | $18.02 | $32.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.30 / $70.81 / $102.72
| Facility | | $21.30 | $70.81 | $102.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.05 / $17.37 / $48.39
| Professional | | $14.05 | $17.37 | $48.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.02 / $155.66 / $155.66
| Facility | | $57.02 | $155.66 | $155.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.76 / $19.66 / $32.77
| Professional | | $13.76 | $19.66 | $32.77 |