- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.85 / $207.11 / $632.80
| Facility | | $24.85 | $207.11 | $632.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $18.32 / $34.54
| Professional | | $13.55 | $18.32 | $34.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.75 / $15.00 / $26.69
| Professional | | $12.75 | $15.00 | $26.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.92 / $16.47 / $20.62
| Facility | | $12.92 | $16.47 | $20.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.89 / $15.47 / $21.98
| Professional | | $12.89 | $15.47 | $21.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.03 / $16.03 / $16.03
| Facility | | $16.03 | $16.03 | $16.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.10 / $37.89 / $71.98
| Professional | | $35.10 | $37.89 | $71.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.78 / $21.85 / $28.00
| Professional | | $13.78 | $21.85 | $28.00 |