- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $70.22 / $70.22
| Facility | | $10.54 | $70.22 | $70.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.94 / $13.12 / $47.70
| Professional | | $12.94 | $13.12 | $47.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.66 / $30.33 / $33.86
| Professional | | $22.66 | $30.33 | $33.86 |
- 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
- $10.54 / $22.58 / $75.65
| Facility | | $10.54 | $22.58 | $75.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $9.49 / $25.59
| Professional | | $4.07 | $9.49 | $25.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $9.99 / $21.82
| Professional | | $4.07 | $9.99 | $21.82 |