- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.10 / $10.10 / $25.97
| Facility | | $10.10 | $10.10 | $25.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.10 / $10.10 / $13.56
| Professional | | $10.10 | $10.10 | $13.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.73 / $29.08 / $32.47
| Professional | | $21.73 | $29.08 | $32.47 |
- 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
- $10.10 / $18.53 / $149.47
| Facility | | $10.10 | $18.53 | $149.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.06 / $16.76 / $24.53
| Professional | | $6.06 | $16.76 | $24.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.06 / $14.72 / $20.55
| Professional | | $6.06 | $14.72 | $20.55 |