- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.50 / $15.33 / $18.75
| Facility | | $11.50 | $15.33 | $18.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $14.07 / $21.23
| Professional | | $9.86 | $14.07 | $21.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.65 / $28.31 / $33.72
| Professional | | $21.65 | $28.31 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $18.34 / $22.92
| Professional | | $12.00 | $18.34 | $22.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.78 / $15.36 / $22.78
| Facility | | $12.78 | $15.36 | $22.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.28 / $17.47 / $91.77
| Professional | | $7.28 | $17.47 | $91.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.18 / $15.66 / $27.66
| Professional | | $11.18 | $15.66 | $27.66 |