- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.63 / $35.93 / $86.25
| Facility | | $19.63 | $35.93 | $86.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $10.70 / $12.49
| Professional | | $10.70 | $10.70 | $12.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.32 / $17.67 / $24.31
| Facility | | $16.32 | $17.67 | $24.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.25 / $11.25 / $20.72
| Professional | | $11.25 | $11.25 | $20.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.26 / $28.62 / $50.31
| Facility | | $11.26 | $28.62 | $50.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.59 / $12.67 / $21.17
| Professional | | $8.59 | $12.67 | $21.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $14.01 / $23.71
| Professional | | $6.30 | $14.01 | $23.71 |