- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.83 / $21.09 / $25.31
| Facility | | $13.83 | $21.09 | $25.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.65 / $13.66 / $13.83
| Professional | | $12.65 | $13.66 | $13.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.55 / $22.77 / $25.31
| Facility | | $18.55 | $22.77 | $25.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.23 / $20.23 / $22.77
| Professional | | $20.23 | $20.23 | $22.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.71 / $30.60 / $50.63
| Facility | | $13.71 | $30.60 | $50.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.58 / $24.26 / $106.51
| Professional | | $9.58 | $24.26 | $106.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.09 / $10.11 / $33.25
| Professional | | $7.09 | $10.11 | $33.25 |