- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.30 / $24.92 / $90.83
| Facility | | $18.30 | $24.92 | $90.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.95 / $19.17 / $22.45
| Professional | | $12.95 | $19.17 | $22.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.70 / $33.72 / $53.14
| Facility | | $18.70 | $33.72 | $53.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.23 / $13.91 / $131.21
| Facility | | $11.23 | $13.91 | $131.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.15 / $19.82 / $24.78
| Professional | | $9.15 | $19.82 | $24.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.25 / $15.54 / $17.27
| Facility | | $7.25 | $15.54 | $17.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.91 / $8.64 / $21.00
| Professional | | $6.91 | $8.64 | $21.00 |