- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.55 / $34.32 / $45.00
| Facility | | $6.55 | $34.32 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.46 / $10.01 / $15.34
| Professional | | $5.46 | $10.01 | $15.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.40 / $11.73 / $36.75
| Facility | | $11.40 | $11.73 | $36.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.27 / $15.28 / $19.10
| Professional | | $3.27 | $15.28 | $19.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.34 / $15.34 / $54.03
| Facility | | $13.34 | $15.34 | $54.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.22 / $10.85 / $15.56
| Professional | | $10.22 | $10.85 | $15.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.06 / $5.60 / $8.00
| Professional | | $3.06 | $5.60 | $8.00 |