- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $51.29 / $208.93
| Facility | | $16.22 | $51.29 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $15.14 / $41.69
| Professional | | $12.02 | $15.14 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.98 / $22.91 / $77.62
| Facility | | $16.98 | $22.91 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $10.23 / $33.88
| Professional | | $8.32 | $10.23 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $32.36 / $77.62
| Facility | | $11.22 | $32.36 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $20.42 / $40.74
| Professional | | $10.72 | $20.42 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.51 / $16.98 / $23.44
| Facility | | $8.51 | $16.98 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $10.23 / $23.44
| Professional | | $7.08 | $10.23 | $23.44 |