- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.69 / $97.93 / $367.00
| Facility | | $12.69 | $97.93 | $367.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.07 / $13.28 / $64.25
| Professional | | $10.07 | $13.28 | $64.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.43 / $13.43 / $13.43
| Professional | | $13.43 | $13.43 | $13.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.92 / $13.05 / $23.81
| Professional | | $10.92 | $13.05 | $23.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.70 / $14.61 / $19.05
| Professional | | $12.70 | $14.61 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.81 / $12.87 / $22.56
| Professional | | $8.81 | $12.87 | $22.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.73 / $13.87 / $17.70
| Professional | | $9.73 | $13.87 | $17.70 |