- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.34 / $81.25 / $115.48
| Facility | | $10.34 | $81.25 | $115.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $4.45 / $4.95
| Professional | | $3.47 | $4.45 | $4.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.70 / $5.83 / $7.00
| Facility | | $4.70 | $5.83 | $7.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.60 / $3.71 / $9.42
| Professional | | $2.60 | $3.71 | $9.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.75 / $11.81 / $20.75
| Facility | | $4.75 | $11.81 | $20.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.58 / $5.48 / $7.23
| Professional | | $3.58 | $5.48 | $7.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.73 / $2.90 / $6.82
| Professional | | $1.73 | $2.90 | $6.82 |