- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.48 / $20.77 / $186.01
| Facility | | $16.48 | $20.77 | $186.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $18.64 / $18.64
| Professional | | $9.86 | $18.64 | $18.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.86 / $15.86 / $15.86
| Facility | | $15.86 | $15.86 | $15.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.52 / $18.78 / $20.87
| Professional | | $12.52 | $18.78 | $20.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.49 / $14.81 / $30.80
| Facility | | $10.49 | $14.81 | $30.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.06 / $14.99 / $20.13
| Professional | | $7.06 | $14.99 | $20.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.84 / $7.61 / $16.76
| Professional | | $5.84 | $7.61 | $16.76 |