- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.68 / $45.00 / $92.21
| Facility | | $23.68 | $45.00 | $92.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.42 / $12.57 / $13.08
| Professional | | $12.42 | $12.57 | $13.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.03 / $17.79 / $29.33
| Facility | | $17.03 | $17.79 | $29.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $10.85 / $27.53
| Professional | | $7.60 | $10.85 | $27.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.51 / $34.53 / $60.71
| Facility | | $13.51 | $34.53 | $60.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $15.98 / $21.17
| Professional | | $10.38 | $15.98 | $21.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $10.56 / $24.40
| Professional | | $5.05 | $10.56 | $24.40 |