- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.43 / $27.27 / $43.29
| Facility | | $14.43 | $27.27 | $43.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.48 / $11.27 / $14.40
| Professional | | $8.48 | $11.27 | $14.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $11.00 / $81.59
| Professional | | $10.00 | $11.00 | $81.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.50 / $81.30 / $116.06
| Professional | | $12.50 | $81.30 | $116.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.67 / $15.65 / $15.65
| Professional | | $14.67 | $15.65 | $15.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.21 / $15.10 / $35.65
| Professional | | $9.21 | $15.10 | $35.65 |