- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.63 / $2.98 / $30.87
| Facility | | $2.63 | $2.98 | $30.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $12.21 / $16.07
| Professional | | $3.50 | $12.21 | $16.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $11.00 / $20.61
| Professional | | $3.00 | $11.00 | $20.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.60 / $20.32 / $60.00
| Professional | | $18.60 | $20.32 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.21 / $14.32 / $20.57
| Professional | | $11.21 | $14.32 | $20.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.18 / $14.16 / $19.60
| Professional | | $5.18 | $14.16 | $19.60 |