- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $20.42 / $38.02
| Facility | | $17.78 | $20.42 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $14.13 / $52.48
| Professional | | $12.88 | $14.13 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.48 / $11.48 / $11.48
| Facility | | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $20.42 / $33.11
| Professional | | $12.59 | $20.42 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $85.11
| Facility | | $17.78 | $17.78 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $11.75 / $26.30
| Professional | | $7.41 | $11.75 | $26.30 |