- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.07 / $35.17 / $310.08
| Facility | | $14.07 | $35.17 | $310.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.82 / $13.45 / $67.20
| Professional | | $10.82 | $13.45 | $67.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.12 / $15.32 / $23.04
| Professional | | $13.12 | $15.32 | $23.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.06 / $14.54 / $23.49
| Professional | | $12.06 | $14.54 | $23.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.11 / $14.12 / $23.48
| Facility | | $12.11 | $14.12 | $23.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.54 / $17.21 / $26.66
| Professional | | $14.54 | $17.21 | $26.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.60 / $18.01 / $27.95
| Professional | | $12.60 | $18.01 | $27.95 |