- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.00 / $20.26 / $95.23
| Facility | | $15.00 | $20.26 | $95.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.44 / $11.74 / $14.36
| Professional | | $10.44 | $11.74 | $14.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.53 / $9.06 / $9.06
| Professional | | $6.53 | $9.06 | $9.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.88 / $16.84 / $22.66
| Facility | | $13.88 | $16.84 | $22.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.06 / $9.53 / $13.32
| Professional | | $9.06 | $9.53 | $13.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.21 / $13.75 / $41.08
| Facility | | $10.21 | $13.75 | $41.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $10.02 / $18.59
| Professional | | $6.83 | $10.02 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.48 / $7.66 / $18.23
| Professional | | $5.48 | $7.66 | $18.23 |