- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.50 / $46.64 / $67.83
| Facility | | $36.50 | $46.64 | $67.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.33 / $6.43 / $8.60
| Professional | | $5.33 | $6.43 | $8.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $14.51 / $16.20
| Professional | | $10.84 | $14.51 | $16.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.26 / $8.34 / $10.49
| Professional | | $8.26 | $8.34 | $10.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.11 / $13.53 / $100.00
| Facility | | $5.11 | $13.53 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.60 / $8.64 / $22.50
| Professional | | $3.60 | $8.64 | $22.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $5.04 / $12.35
| Professional | | $3.02 | $5.04 | $12.35 |