- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.86 / $18.57 / $75.45
| Facility | | $13.86 | $18.57 | $75.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $13.86 / $19.62
| Professional | | $10.74 | $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
- $8.36 / $8.81 / $12.30
| Professional | | $8.36 | $8.81 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.86 / $30.65 / $118.09
| Facility | | $4.86 | $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 / $5.05 / $15.06
| Professional | | $5.05 | $5.05 | $15.06 |