- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.20 / $18.48 / $75.11
| Facility | | $13.20 | $18.48 | $75.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.71 / $10.81 / $13.80
| Professional | | $10.71 | $10.81 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.33 / $8.33 / $8.33
| Professional | | $8.33 | $8.33 | $8.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.88 / $16.84 / $22.66
| Facility | | $13.88 | $16.84 | $22.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.33 / $8.77 / $12.25
| Professional | | $8.33 | $8.77 | $12.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.39 / $12.64 / $38.00
| Facility | | $9.39 | $12.64 | $38.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.32 / $9.23 / $17.04
| Professional | | $6.32 | $9.23 | $17.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $7.05 / $16.78
| Professional | | $5.04 | $7.05 | $16.78 |