- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.01 / $187.80 / $622.50
| Facility | | $14.01 | $187.80 | $622.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.89 / $15.10 / $27.87
| Professional | | $9.89 | $15.10 | $27.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.73 / $20.73 / $20.73
| Facility | | $20.73 | $20.73 | $20.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.73 / $20.73 / $20.73
| Professional | | $20.73 | $20.73 | $20.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.92 / $10.41 / $18.11
| Facility | | $8.92 | $10.41 | $18.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.52 / $9.17 / $19.62
| Professional | | $5.52 | $9.17 | $19.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $6.87 / $23.44
| Professional | | $4.84 | $6.87 | $23.44 |