- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.85 / $70.22 / $302.72
| Facility | | $59.85 | $70.22 | $302.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.67 / $19.80 / $20.62
| Professional | | $9.67 | $19.80 | $20.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.03 / $24.28 / $27.25
| Professional | | $20.03 | $24.28 | $27.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.63 / $13.77 / $17.30
| Professional | | $13.63 | $13.77 | $17.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.07 / $18.07 / $60.00
| Facility | | $8.07 | $18.07 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $11.53 / $19.60
| Professional | | $4.84 | $11.53 | $19.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $11.76 / $16.14
| Professional | | $4.84 | $11.76 | $16.14 |