- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.86 / $18.71 / $75.45
| Facility | | $13.86 | $18.71 | $75.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.50 / $13.86 / $19.62
| Professional | | $10.50 | $13.86 | $19.62 |
- 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
- $10.13 / $12.30 / $24.48
| Professional | | $10.13 | $12.30 | $24.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.83 / $30.65 / $118.09
| Facility | | $7.83 | $30.65 | $118.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $43.37 / $54.21
| Professional | | $6.75 | $43.37 | $54.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $6.30 / $15.85
| Professional | | $5.05 | $6.30 | $15.85 |