- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.43 / $94.50 / $117.73
| Facility | | $19.43 | $94.50 | $117.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.31 / $5.66 / $6.48
| Professional | | $5.31 | $5.66 | $6.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.63 / $7.97 / $13.15
| Facility | | $7.63 | $7.97 | $13.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.40 / $4.86 / $12.33
| Professional | | $3.40 | $4.86 | $12.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.00 / $15.47 / $27.20
| Facility | | $6.00 | $15.47 | $27.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.65 / $7.17 / $9.28
| Professional | | $4.65 | $7.17 | $9.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $4.73 / $10.37
| Professional | | $2.27 | $4.73 | $10.37 |