- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.98 / $25.86 / $60.02
| Facility | | $13.98 | $25.86 | $60.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.22 / $13.98 / $15.84
| Professional | | $12.22 | $13.98 | $15.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.69 / $13.98 / $29.82
| Professional | | $9.69 | $13.98 | $29.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.12 / $36.65 / $47.60
| Facility | | $12.12 | $36.65 | $47.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.10 / $10.44 / $28.40
| Professional | | $8.10 | $10.44 | $28.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.43 / $88.54 / $88.54
| Facility | | $32.43 | $88.54 | $88.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $11.18 / $18.64
| Professional | | $7.83 | $11.18 | $18.64 |