- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.28 / $36.34 / $104.37
| Facility | | $14.28 | $36.34 | $104.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $13.05 / $15.08
| Professional | | $10.56 | $13.05 | $15.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.08 / $19.27 / $52.18
| Facility | | $15.08 | $19.27 | $52.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.44 / $7.44 / $16.85
| Professional | | $7.44 | $7.44 | $16.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $24.50 / $50.47
| Facility | | $10.54 | $24.50 | $50.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.51 / $17.35 / $22.11
| Professional | | $9.51 | $17.35 | $22.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.34 / $15.08 / $18.95
| Facility | | $11.34 | $15.08 | $18.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.33 / $9.05 / $21.06
| Professional | | $6.33 | $9.05 | $21.06 |