- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.55 / $54.10 / $103.79
| Facility | | $29.55 | $54.10 | $103.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $14.80 / $15.73
| Professional | | $13.06 | $14.80 | $15.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.26 / $22.20 / $24.57
| Facility | | $21.26 | $22.20 | $24.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.54 / $13.54 / $34.11
| Professional | | $13.54 | $13.54 | $34.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.07 / $53.24 / $75.72
| Facility | | $43.07 | $53.24 | $75.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.35 / $20.65 / $25.81
| Professional | | $12.35 | $20.65 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.32 / $12.32 / $35.71
| Professional | | $6.32 | $12.32 | $35.71 |