- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.55 / $30.10 / $259.20
| Facility | | $16.55 | $30.10 | $259.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.13 / $13.45 / $17.57
| Professional | | $11.13 | $13.45 | $17.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.53 / $7.53 / $10.46
| Professional | | $7.53 | $7.53 | $10.46 |
- 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
- $7.06 / $7.43 / $10.37
| Professional | | $7.06 | $7.43 | $10.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.77 / $15.87 / $47.24
| Facility | | $11.77 | $15.87 | $47.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.85 / $14.46 / $21.68
| Professional | | $7.85 | $14.46 | $21.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.30 / $9.02 / $15.05
| Professional | | $8.30 | $9.02 | $15.05 |