- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.07 / $84.21 / $110.40
| Facility | | $16.07 | $84.21 | $110.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.09 / $11.35 / $14.58
| Professional | | $9.09 | $11.35 | $14.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.84 / $11.14 / $34.93
| Facility | | $10.84 | $11.14 | $34.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.95 / $14.46 / $18.07
| Professional | | $7.95 | $14.46 | $18.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.68 / $14.58 / $57.06
| Facility | | $12.68 | $14.58 | $57.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.69 / $10.31 / $14.76
| Professional | | $9.69 | $10.31 | $14.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.33 / $7.50 / $7.61
| Professional | | $5.33 | $7.50 | $7.61 |