- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.39 / $125.64 / $222.85
| Facility | | $10.39 | $125.64 | $222.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.58 / $10.35 / $10.68
| Professional | | $8.58 | $10.35 | $10.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.40 / $10.70 / $17.34
| Professional | | $9.40 | $10.70 | $17.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.15 / $8.02 / $15.02
| Facility | | $6.15 | $8.02 | $15.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.15 / $12.32 / $18.72
| Professional | | $6.15 | $12.32 | $18.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.61 / $14.51 / $17.42
| Professional | | $11.61 | $14.51 | $17.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.22 / $6.97 / $10.56
| Professional | | $5.22 | $6.97 | $10.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.53 / $5.81 / $11.39
| Professional | | $4.53 | $5.81 | $11.39 |