- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.34 / $8.34 / $21.46
| Facility | | $8.34 | $8.34 | $21.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.34 / $10.72 / $88.20
| Professional | | $8.34 | $10.72 | $88.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.94 / $24.02 / $26.82
| Professional | | $17.94 | $24.02 | $26.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.63 / $13.77 / $17.30
| Professional | | $13.63 | $13.77 | $17.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.34 / $17.88 / $101.22
| Facility | | $8.34 | $17.88 | $101.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.91 / $14.30 / $20.44
| Professional | | $5.91 | $14.30 | $20.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $8.34 / $20.44
| Professional | | $5.01 | $8.34 | $20.44 |