- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.17 / $19.62 / $26.40
| Facility | | $16.17 | $19.62 | $26.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.61 / $1.18 / $3,138.00
| Facility | | $0.61 | $1.18 | $3,138.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $20.23 / $25.30
| Professional | | $10.73 | $20.23 | $25.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.05 / $10.05 / $10.77
| Facility | | $10.05 | $10.05 | $10.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $10.16 / $22.57
| Professional | | $9.02 | $10.16 | $22.57 |