- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.23 / $95.71 / $124.88
| Facility | | $18.23 | $95.71 | $124.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $12.85 / $16.39
| Professional | | $10.65 | $12.85 | $16.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $12.65 / $39.63
| Facility | | $12.30 | $12.65 | $39.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.03 / $16.52 / $20.65
| Professional | | $9.03 | $16.52 | $20.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.39 / $16.55 / $64.76
| Facility | | $14.39 | $16.55 | $64.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.02 / $11.67 / $16.76
| Professional | | $11.02 | $11.67 | $16.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.04 / $8.56 / $8.63
| Professional | | $6.04 | $8.56 | $8.63 |