- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.26 / $26.01 / $74.40
| Facility | | $19.26 | $26.01 | $74.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.14 / $13.67 / $19.27
| Professional | | $13.14 | $13.67 | $19.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.05 / $10.48 / $10.48
| Professional | | $9.05 | $10.48 | $10.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.17 / $19.62 / $26.40
| Facility | | $16.17 | $19.62 | $26.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $11.01 / $15.38
| Professional | | $10.46 | $11.01 | $15.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.78 / $15.88 / $52.37
| Facility | | $11.78 | $15.88 | $52.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.33 / $12.28 / $24.26
| Professional | | $8.33 | $12.28 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $10.06 / $19.95
| Professional | | $10.06 | $10.06 | $19.95 |