- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.35 / $57.01 / $120.72
| Facility | | $10.35 | $57.01 | $120.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.51 / $6.28 / $15.00
| Professional | | $5.51 | $6.28 | $15.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.61 / $10.14 / $12.82
| Facility | | $8.61 | $10.14 | $12.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $6.46 / $12.04
| Professional | | $4.51 | $6.46 | $12.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.00 / $15.10 / $26.54
| Facility | | $6.00 | $15.10 | $26.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.65 / $6.99 / $12.39
| Professional | | $4.65 | $6.99 | $12.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.01 / $6.63 / $12.50
| Professional | | $3.01 | $6.63 | $12.50 |