- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.35 / $94.70 / $122.39
| Facility | | $39.35 | $94.70 | $122.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $12.36 / $15.79
| Professional | | $10.30 | $12.36 | $15.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.73 / $12.06 / $37.81
| Facility | | $11.73 | $12.06 | $37.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.57 / $15.69 / $19.62
| Professional | | $8.57 | $15.69 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.73 / $15.79 / $61.80
| Facility | | $13.73 | $15.79 | $61.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.51 / $11.12 / $15.96
| Professional | | $10.51 | $11.12 | $15.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $8.11 / $8.24
| Professional | | $5.77 | $8.11 | $8.24 |