- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.57 / $43.14 / $97.12
| Facility | | $23.57 | $43.14 | $97.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.85 / $13.85 / $14.64
| Professional | | $13.85 | $13.85 | $14.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.57 / $19.89 / $21.62
| Facility | | $19.57 | $19.89 | $21.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.67 / $12.67 / $27.40
| Professional | | $12.67 | $12.67 | $27.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.35 / $44.83 / $60.38
| Facility | | $34.35 | $44.83 | $60.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $19.41 / $24.26
| Professional | | $10.38 | $19.41 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.91 / $10.13 / $28.47
| Professional | | $5.91 | $10.13 | $28.47 |