- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.64 / $19.68 / $48.54
| Facility | | $10.64 | $19.68 | $48.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.64 / $12.05 / $14.18
| Professional | | $10.64 | $12.05 | $14.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.80 / $15.41 / $18.91
| Professional | | $7.80 | $15.41 | $18.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.40 / $30.66 / $54.18
| Facility | | $9.40 | $30.66 | $54.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.41 / $10.66 / $20.65
| Professional | | $6.41 | $10.66 | $20.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.67 / $70.00 / $70.00
| Facility | | $24.67 | $70.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.96 / $9.52 / $19.37
| Professional | | $5.96 | $9.52 | $19.37 |