- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.59 / $75.14 / $146.51
| Facility | | $57.59 | $75.14 | $146.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.02 / $41.13 / $51.41
| Professional | | $26.02 | $41.13 | $51.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.50 / $4.50 / $11.77
| Facility | | $3.50 | $4.50 | $11.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.69 / $12.69 / $12.69
| Professional | | $12.69 | $12.69 | $12.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.08 / $11.08 / $11.08
| Facility | | $11.08 | $11.08 | $11.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.08 / $11.08 / $11.08
| Professional | | $11.08 | $11.08 | $11.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.69 / $12.69 / $12.69
| Professional | | $12.69 | $12.69 | $12.69 |