- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.60 / $54.24 / $97.47
| Facility | | $26.60 | $54.24 | $97.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.61 / $13.32 / $13.89
| Professional | | $9.61 | $13.32 | $13.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.57 / $29.78 / $33.43
| Professional | | $24.57 | $29.78 | $33.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $17.10 / $21.50
| Professional | | $16.93 | $17.10 | $21.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.35 / $22.17 / $100.00
| Facility | | $10.35 | $22.17 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.33 / $17.73 / $25.35
| Professional | | $7.33 | $17.73 | $25.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.21 / $10.34 / $25.35
| Professional | | $6.21 | $10.34 | $25.35 |