- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $33.88 / $70.79
| Facility | | $10.23 | $33.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $5.25 / $36.31
| Professional | | $5.01 | $5.25 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $11.48 / $12.88
| Professional | | $8.32 | $11.48 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $6.61 / $8.32
| Professional | | $6.61 | $6.61 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.98 / $15.14 / $61.66
| Facility | | $3.98 | $15.14 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $3.98 / $9.77
| Professional | | $2.82 | $3.98 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $5.89 / $9.77
| Professional | | $2.82 | $5.89 | $9.77 |