- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.07 / $32.72 / $32.72
| Facility | | $8.07 | $32.72 | $32.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.49 / $10.28 / $10.46
| Professional | | $7.49 | $10.28 | $10.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.17 / $23.23 / $26.07
| Professional | | $19.17 | $23.23 | $26.07 |
- 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
- $8.07 / $17.30 / $68.88
| Facility | | $8.07 | $17.30 | $68.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.71 / $13.84 / $19.76
| Professional | | $5.71 | $13.84 | $19.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $13.84 / $19.76
| Professional | | $4.84 | $13.84 | $19.76 |