- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.30 / $112.27 / $148.07
| Facility | | $19.30 | $112.27 | $148.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.55 / $19.30 / $24.21
| Professional | | $12.55 | $19.30 | $24.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.08 / $36.93 / $43.60
| Professional | | $29.08 | $36.93 | $43.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.13 / $22.35 / $27.66
| Professional | | $22.13 | $22.35 | $27.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.88 / $54.31 / $143.10
| Facility | | $18.88 | $54.31 | $143.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.11 / $12.87 / $31.54
| Professional | | $9.11 | $12.87 | $31.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.11 / $25.70 / $31.54
| Professional | | $8.11 | $25.70 | $31.54 |