- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.48 / $26.29 / $160.44
| Facility | | $19.48 | $26.29 | $160.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.56 / $14.78 / $29.52
| Professional | | $14.56 | $14.78 | $29.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.29 / $11.76 / $11.76
| Professional | | $11.29 | $11.76 | $11.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.73 / $20.32 / $27.34
| Facility | | $16.73 | $20.32 | $27.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.76 / $12.38 / $17.29
| Professional | | $11.76 | $12.38 | $17.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.25 / $17.85 / $53.40
| Facility | | $13.25 | $17.85 | $53.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.88 / $13.02 / $24.26
| Professional | | $8.88 | $13.02 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.11 / $9.94 / $23.67
| Professional | | $7.11 | $9.94 | $23.67 |