- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.84 / $27.50 / $129.40
| Facility | | $15.84 | $27.50 | $129.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.75 / $12.68 / $16.73
| Professional | | $10.75 | $12.68 | $16.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.28 / $10.11 / $10.11
| Professional | | $7.28 | $10.11 | $10.11 |
- 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
- $10.11 / $10.64 / $14.85
| Professional | | $10.11 | $10.64 | $14.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.38 / $15.32 / $45.18
| Facility | | $11.38 | $15.32 | $45.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.68 / $13.96 / $21.17
| Professional | | $7.68 | $13.96 | $21.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.11 / $8.73 / $25.41
| Professional | | $6.11 | $8.73 | $25.41 |