- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.26 / $12.69 / $167.83
| Facility | | $10.26 | $12.69 | $167.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.51 / $9.41 / $12.68
| Professional | | $6.51 | $9.41 | $12.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.82 / $11.02 / $11.67
| Professional | | $8.82 | $11.02 | $11.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.53 / $11.43 / $17.94
| Professional | | $6.53 | $11.43 | $17.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.22 / $9.38 / $14.38
| Professional | | $7.22 | $9.38 | $14.38 |