- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.66 / $22.07 / $29.36
| Facility | | $15.66 | $22.07 | $29.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.58 / $16.50 / $29.36
| Professional | | $12.58 | $16.50 | $29.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.03 / $16.03 / $27.26
| Professional | | $13.03 | $16.03 | $27.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $15.00 / $15.00
| Professional | | $15.00 | $15.00 | $15.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.30 / $29.36 / $65.75
| Facility | | $16.30 | $29.36 | $65.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $14.65 / $146.31
| Professional | | $10.38 | $14.65 | $146.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $14.52 / $21.72
| Professional | | $9.77 | $14.52 | $21.72 |