- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.44 / $86.52 / $133.72
| Facility | | $22.44 | $86.52 | $133.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.28 / $11.24 / $16.41
| Professional | | $10.28 | $11.24 | $16.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.14 / $16.86 / $27.80
| Facility | | $16.14 | $16.86 | $27.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.20 / $10.28 / $22.84
| Professional | | $7.20 | $10.28 | $22.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.76 / $32.71 / $57.51
| Facility | | $12.76 | $32.71 | $57.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.84 / $11.67 / $19.62
| Professional | | $9.84 | $11.67 | $19.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $9.59 / $27.12
| Professional | | $5.25 | $9.59 | $27.12 |