- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.48 / $53.21 / $107.52
| Facility | | $20.48 | $53.21 | $107.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.96 / $14.45 / $18.61
| Professional | | $11.96 | $14.45 | $18.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.83 / $14.23 / $44.59
| Facility | | $13.83 | $14.23 | $44.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.13 / $18.59 / $23.23
| Professional | | $10.13 | $18.59 | $23.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.18 / $18.61 / $72.78
| Facility | | $16.18 | $18.61 | $72.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.38 / $13.29 / $18.75
| Professional | | $12.38 | $13.29 | $18.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.80 / $9.56 / $22.61
| Professional | | $6.80 | $9.56 | $22.61 |