- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $19.50 / $47.88
| Facility | | $10.54 | $19.50 | $47.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $11.24 / $12.92
| Professional | | $10.54 | $11.24 | $12.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.73 / $15.61 / $17.14
| Professional | | $7.73 | $15.61 | $17.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.31 / $29.93 / $54.18
| Facility | | $9.31 | $29.93 | $54.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.41 / $10.80 / $20.60
| Professional | | $6.41 | $10.80 | $20.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.52 / $120.35 / $120.35
| Facility | | $34.52 | $120.35 | $120.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.90 / $8.64 / $17.80
| Professional | | $5.90 | $8.64 | $17.80 |