- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.67 / $44.26 / $81.23
| Facility | | $28.67 | $44.26 | $81.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $12.30 / $13.68
| Professional | | $10.26 | $12.30 | $13.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.08 / $12.61 / $20.39
| Professional | | $11.08 | $12.61 | $20.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.25 / $9.46 / $17.70
| Facility | | $7.25 | $9.46 | $17.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.25 / $14.52 / $22.20
| Professional | | $7.25 | $14.52 | $22.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.68 / $17.10 / $20.52
| Professional | | $13.68 | $17.10 | $20.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $8.08 / $10.40
| Professional | | $5.75 | $8.08 | $10.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $13.42 / $13.42
| Professional | | $6.75 | $13.42 | $13.42 |