- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.32 / $161.59 / $259.70
| Facility | | $9.32 | $161.59 | $259.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $10.35 / $26.40
| Professional | | $8.32 | $10.35 | $26.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.34 / $12.60 / $17.14
| Professional | | $11.34 | $12.60 | $17.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.68 / $8.27 / $16.30
| Facility | | $6.68 | $8.27 | $16.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $12.03 / $18.28
| Professional | | $5.75 | $12.03 | $18.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.60 / $15.75 / $18.89
| Professional | | $12.60 | $15.75 | $18.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.67 / $6.30 / $11.47
| Professional | | $5.67 | $6.30 | $11.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.38 / $10.02 / $10.02
| Professional | | $5.38 | $10.02 | $10.02 |