- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.63 / $107.94 / $242.49
| Facility | | $65.63 | $107.94 | $242.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.50 / $12.21 / $14.42
| Professional | | $10.50 | $12.21 | $14.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.69 / $12.02 / $37.68
| Facility | | $11.69 | $12.02 | $37.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.57 / $15.69 / $19.62
| Professional | | $8.57 | $15.69 | $19.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.64 / $23.63 / $23.63
| Professional | | $18.64 | $23.63 | $23.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.68 / $15.73 / $61.56
| Facility | | $13.68 | $15.73 | $61.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $11.12 / $15.96
| Professional | | $10.47 | $11.12 | $15.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $7.82 / $8.21
| Professional | | $5.75 | $7.82 | $8.21 |