- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.55 / $92.01 / $120.64
| Facility | | $17.55 | $92.01 | $120.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.49 / $12.32 / $17.55
| Professional | | $10.49 | $12.32 | $17.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.12 / $12.47 / $39.08
| Facility | | $12.12 | $12.47 | $39.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.73 / $16.52 / $20.65
| Professional | | $8.73 | $16.52 | $20.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.18 / $16.30 / $62.41
| Facility | | $14.18 | $16.30 | $62.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.85 / $11.67 / $16.36
| Professional | | $10.85 | $11.67 | $16.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.96 / $8.19 / $8.51
| Professional | | $5.96 | $8.19 | $8.51 |