- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.84 / $43.65 / $90.74
| Facility | | $23.84 | $43.65 | $90.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.94 / $12.94 / $15.16
| Professional | | $12.94 | $12.94 | $15.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.59 / $19.41 / $20.20
| Facility | | $18.59 | $19.41 | $20.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.84 / $11.84 / $27.73
| Professional | | $11.84 | $11.84 | $27.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.51 / $34.77 / $61.13
| Facility | | $13.51 | $34.77 | $61.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $16.10 / $22.72
| Professional | | $10.56 | $16.10 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.63 / $15.78 / $25.25
| Professional | | $6.63 | $15.78 | $25.25 |