- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.60 / $74.76 / $363.08
| Facility | | $18.60 | $74.76 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $12.18 / $19.02
| Professional | | $10.27 | $12.18 | $19.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.85 / $12.39 / $22.21
| Professional | | $10.85 | $12.39 | $22.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $11.00 / $11.00
| Professional | | $11.00 | $11.00 | $11.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.83 / $13.32 / $16.73
| Professional | | $9.83 | $13.32 | $16.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.66 / $11.40 / $18.10
| Professional | | $8.66 | $11.40 | $18.10 |