- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.05 / $17.30 / $81.48
| Facility | | $15.05 | $17.30 | $81.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.94 / $25.24 / $26.08
| Professional | | $12.94 | $25.24 | $26.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.53 / $7.53 / $7.53
| Professional | | $7.53 | $7.53 | $7.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.88 / $16.84 / $22.66
| Facility | | $13.88 | $16.84 | $22.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $11.01 / $15.37
| Professional | | $10.46 | $11.01 | $15.37 |
- 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 / $11.58 / $21.68
| Professional | | $7.85 | $11.58 | $21.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.32 / $8.83 / $21.03
| Professional | | $6.32 | $8.83 | $21.03 |