- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.08 / $41.67 / $93.51
| Facility | | $28.08 | $41.67 | $93.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.45 / $12.55 / $25.44
| Professional | | $10.45 | $12.55 | $25.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.44 / $13.04 / $21.08
| Professional | | $11.44 | $13.04 | $21.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.48 / $9.77 / $18.27
| Facility | | $7.48 | $9.77 | $18.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $15.01 / $23.07
| Professional | | $7.48 | $15.01 | $23.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.12 / $17.64 / $21.18
| Professional | | $14.12 | $17.64 | $21.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.35 / $8.47 / $11.93
| Professional | | $6.35 | $8.47 | $11.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.51 / $7.06 / $13.86
| Professional | | $5.51 | $7.06 | $13.86 |