- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.23 / $92.04 / $125.24
| Facility | | $18.23 | $92.04 | $125.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $12.56 / $18.23
| Professional | | $10.65 | $12.56 | $18.23 |
- 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 / $8.51 / $8.63
| Professional | | $6.04 | $8.51 | $8.63 |