- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.06 / $38.54 / $74.00
| Facility | | $21.06 | $38.54 | $74.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.55 / $10.55 / $13.40
| Professional | | $10.55 | $10.55 | $13.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.16 / $15.83 / $26.09
| Facility | | $15.16 | $15.83 | $26.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $9.65 / $24.50
| Professional | | $6.76 | $9.65 | $24.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.01 / $30.71 / $53.98
| Facility | | $12.01 | $30.71 | $53.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.31 / $11.54 / $18.59
| Professional | | $9.31 | $11.54 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.50 / $9.40 / $25.46
| Professional | | $4.50 | $9.40 | $25.46 |