- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.85 / $147.35 / $148.05
| Facility | | $10.85 | $147.35 | $148.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.85 / $17.05 / $155.75
| Professional | | $10.85 | $17.05 | $155.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.42 / $31.23 / $35.04
| Professional | | $23.42 | $31.23 | $35.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.76 / $17.94 / $22.55
| Professional | | $17.76 | $17.94 | $22.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.85 / $23.25 / $101.29
| Facility | | $10.85 | $23.25 | $101.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.30 / $17.01 / $26.58
| Professional | | $9.30 | $17.01 | $26.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.30 / $17.01 / $26.58
| Professional | | $9.30 | $17.01 | $26.58 |