- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.82 / $86.65 / $259.48
| Facility | | $25.82 | $86.65 | $259.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.84 / $51.34 / $118.17
| Professional | | $24.84 | $51.34 | $118.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $21.88 / $30.63
| Professional | | $21.88 | $21.88 | $30.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $27.00 / $27.00
| Professional | | $27.00 | $27.00 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.77 / $60.94 / $107.30
| Professional | | $24.77 | $60.94 | $107.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.48 / $82.25 / $132.30
| Professional | | $62.48 | $82.25 | $132.30 |