- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.03 / $40.74 / $81.28
| Facility | | $6.03 | $40.74 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $6.03 / $12.02
| Professional | | $3.98 | $6.03 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $13.49 / $15.14
| Professional | | $9.77 | $13.49 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $7.76 / $10.00
| Professional | | $7.76 | $7.76 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.68 / $20.42 / $52.48
| Facility | | $4.68 | $20.42 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $4.68 / $11.48
| Professional | | $3.31 | $4.68 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $6.76 / $11.48
| Professional | | $3.31 | $6.76 | $11.48 |