- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.23 / $47.49 / $166.52
| Facility | | $11.23 | $47.49 | $166.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.36 / $11.23 / $12.43
| Professional | | $10.36 | $11.23 | $12.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.52 / $11.94 / $65.00
| Facility | | $8.52 | $11.94 | $65.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.82 / $21.06 / $26.33
| Professional | | $19.82 | $21.06 | $26.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.81 / $10.36 / $20.46
| Professional | | $9.81 | $10.36 | $20.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.04 / $7.25 / $22.48
| Professional | | $6.04 | $7.25 | $22.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.94 / $10.36 / $10.36
| Professional | | $8.94 | $10.36 | $10.36 |