- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.32 / $25.32 / $40.57
| Facility | | $25.32 | $25.32 | $40.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.68 / $19.50 / $32.34
| Professional | | $14.68 | $19.50 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.63 / $25.32 / $36.21
| Facility | | $24.63 | $25.32 | $36.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.67 / $17.36 / $200.67
| Professional | | $2.67 | $17.36 | $200.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.66 / $16.80 / $26.52
| Professional | | $2.66 | $16.80 | $26.52 |