- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.09 / $71.56 / $71.56
| Facility | | $10.09 | $71.56 | $71.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.36 / $12.86 / $13.55
| Professional | | $9.36 | $12.86 | $13.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.70 / $29.04 / $32.42
| Professional | | $21.70 | $29.04 | $32.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $17.10 / $21.50
| Professional | | $16.93 | $17.10 | $21.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.09 / $21.62 / $72.25
| Facility | | $10.09 | $21.62 | $72.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.14 / $17.29 / $24.50
| Professional | | $7.14 | $17.29 | $24.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.05 / $14.70 / $24.50
| Professional | | $6.05 | $14.70 | $24.50 |