- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.01 / $18.48 / $81.64
| Facility | | $10.01 | $18.48 | $81.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.01 / $10.01 / $10.01
| Professional | | $10.01 | $10.01 | $10.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.34 / $22.63 / $51.79
| Professional | | $9.34 | $22.63 | $51.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.68 / $22.54 / $48.80
| Facility | | $21.68 | $22.54 | $48.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.27 / $15.28 / $19.10
| Professional | | $7.27 | $15.28 | $19.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.12 / $27.12 / $27.12
| Professional | | $27.12 | $27.12 | $27.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.04 / $5.60 / $12.14
| Professional | | $3.04 | $5.60 | $12.14 |