- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.00 / $27.46 / $56.41
| Facility | | $15.00 | $27.46 | $56.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.03 / $8.03 / $9.55
| Professional | | $8.03 | $8.03 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.55 / $12.07 / $18.57
| Facility | | $11.55 | $12.07 | $18.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.15 / $7.36 / $17.43
| Professional | | $5.15 | $7.36 | $17.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.50 / $21.87 / $38.45
| Facility | | $8.50 | $21.87 | $38.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.62 / $9.31 / $13.94
| Professional | | $6.62 | $9.31 | $13.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.43 / $8.40 / $15.70
| Professional | | $3.43 | $8.40 | $15.70 |