- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.88 / $70.22 / $155.32
| Facility | | $7.88 | $70.22 | $155.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $10.02 / $13.46
| Professional | | $8.32 | $10.02 | $13.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $22.69 / $25.47
| Professional | | $17.02 | $22.69 | $25.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.22 / $13.35 / $16.78
| Professional | | $13.22 | $13.35 | $16.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.88 / $17.27 / $72.23
| Facility | | $7.88 | $17.27 | $72.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.58 / $13.51 / $19.14
| Professional | | $5.58 | $13.51 | $19.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.73 / $6.77 / $16.60
| Professional | | $4.73 | $6.77 | $16.60 |