- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $27.58
| Facility | | $10.72 | $10.72 | $27.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.33 / $13.36 / $13.91
| Professional | | $11.33 | $13.36 | $13.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $30.87 / $34.64
| Professional | | $25.47 | $30.87 | $34.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $17.52 / $22.03
| Professional | | $17.35 | $17.52 | $22.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $22.98 / $127.51
| Facility | | $10.72 | $22.98 | $127.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $18.38 / $26.04
| Professional | | $7.60 | $18.38 | $26.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.43 / $8.24 / $22.21
| Professional | | $6.43 | $8.24 | $22.21 |