- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.98 / $25.70 / $75.86
| Facility | | $3.98 | $25.70 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $17.38 / $53.70
| Professional | | $3.80 | $17.38 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $25.12 / $30.90
| Professional | | $25.12 | $25.12 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $16.98 / $54.95
| Professional | | $12.02 | $16.98 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.00 / $20.42 / $32.36
| Facility | | $10.00 | $20.42 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $14.13 / $28.18
| Professional | | $10.00 | $14.13 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $14.13 / $20.42
| Professional | | $14.13 | $14.13 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $12.02 / $26.30
| Professional | | $10.72 | $12.02 | $26.30 |