- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.05 / $23.06 / $40.10
| Facility | | $20.05 | $23.06 | $40.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.48 / $23.06 / $23.42
| Professional | | $17.48 | $23.06 | $23.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.59 / $11.64 / $15.66
| Facility | | $9.59 | $11.64 | $15.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.70 / $16.57 / $23.75
| Professional | | $13.70 | $16.57 | $23.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.69 / $21.13 / $62.64
| Facility | | $15.69 | $21.13 | $62.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $15.42 / $111.44
| Professional | | $10.23 | $15.42 | $111.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.42 / $10.02 / $16.53
| Professional | | $8.42 | $10.02 | $16.53 |