- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.43 / $42.75 / $193.21
| Facility | | $12.43 | $42.75 | $193.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.83 / $12.41 / $26.40
| Professional | | $9.83 | $12.41 | $26.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.60 / $13.86 / $43.60
| Facility | | $12.60 | $13.86 | $43.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $7.68 / $12.12
| Professional | | $5.56 | $7.68 | $12.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.77 / $19.64 / $38.23
| Facility | | $8.77 | $19.64 | $38.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.13 / $14.46 / $19.38
| Professional | | $7.13 | $14.46 | $19.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.40 / $12.40 / $12.40
| Facility | | $12.40 | $12.40 | $12.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.29 / $7.56 / $15.12
| Professional | | $5.29 | $7.56 | $15.12 |