- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.52 / $211.62 / $303.70
| Facility | | $9.52 | $211.62 | $303.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $11.85 / $12.78
| Professional | | $10.06 | $11.85 | $12.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.55 / $27.40 / $30.75
| Professional | | $20.55 | $27.40 | $30.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.69 / $15.85 / $19.93
| Professional | | $15.69 | $15.85 | $19.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.52 / $20.39 / $72.80
| Facility | | $9.52 | $20.39 | $72.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.71 / $16.32 / $23.12
| Professional | | $5.71 | $16.32 | $23.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.71 / $7.75 / $19.04
| Professional | | $5.71 | $7.75 | $19.04 |