- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.10 / $72.48 / $103.74
| Facility | | $15.10 | $72.48 | $103.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.82 / $10.64 / $15.10
| Professional | | $8.82 | $10.64 | $15.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.19 / $10.48 / $32.85
| Facility | | $10.19 | $10.48 | $32.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $13.63 / $17.04
| Professional | | $7.48 | $13.63 | $17.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.92 / $13.71 / $53.62
| Facility | | $11.92 | $13.71 | $53.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.13 / $9.76 / $13.57
| Professional | | $9.13 | $9.76 | $13.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $7.05 / $7.15
| Professional | | $5.01 | $7.05 | $7.15 |