- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.38 / $41.85 / $77.34
| Facility | | $10.38 | $41.85 | $77.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.78 / $3.78 / $3.78
| Professional | | $3.78 | $3.78 | $3.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $13.87 / $31.72
| Professional | | $3.53 | $13.87 | $31.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.19 / $8.52 / $17.86
| Facility | | $8.19 | $8.52 | $17.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.68 / $5.78 / $7.23
| Professional | | $2.68 | $5.78 | $7.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.24 / $10.24 / $10.24
| Professional | | $10.24 | $10.24 | $10.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.66 / $3.02 / $7.00
| Professional | | $2.66 | $3.02 | $7.00 |