- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.63 / $48.00 / $95.05
| Facility | | $19.63 | $48.00 | $95.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $12.49 / $20.00
| Professional | | $10.46 | $12.49 | $20.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.32 / $19.47 / $24.31
| Facility | | $16.32 | $19.47 | $24.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.40 / $12.40 / $20.72
| Professional | | $12.40 | $12.40 | $20.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.26 / $28.62 / $50.31
| Facility | | $11.26 | $28.62 | $50.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.59 / $12.67 / $23.75
| Professional | | $8.59 | $12.67 | $23.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.79 / $16.53 / $23.71
| Professional | | $5.79 | $16.53 | $23.71 |