- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.04 / $68.62 / $122.58
| Facility | | $37.04 | $68.62 | $122.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.68 / $13.02 / $14.57
| Professional | | $12.68 | $13.02 | $14.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.94 / $29.36 / $32.78
| Professional | | $21.94 | $29.36 | $32.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $17.10 / $21.50
| Professional | | $16.93 | $17.10 | $21.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.34 / $30.60 / $138.60
| Facility | | $10.34 | $30.60 | $138.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.29 / $17.48 / $29.14
| Professional | | $7.29 | $17.48 | $29.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.12 / $10.19 / $24.99
| Professional | | $6.12 | $10.19 | $24.99 |