- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.02 / $52.52 / $65.14
| Facility | | $10.02 | $52.52 | $65.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.02 / $11.74 / $15.49
| Professional | | $10.02 | $11.74 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.56 / $28.85 / $32.22
| Professional | | $21.56 | $28.85 | $32.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.52 / $16.69 / $20.98
| Professional | | $16.52 | $16.69 | $20.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.17 / $36.21 / $75.43
| Facility | | $10.17 | $36.21 | $75.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.16 / $17.18 / $45.00
| Professional | | $7.16 | $17.18 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.01 / $14.61 / $22.20
| Professional | | $6.01 | $14.61 | $22.20 |