- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.50 / $37.53 / $71.98
| Facility | | $20.50 | $37.53 | $71.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $13.05
| Professional | | $10.27 | $10.27 | $13.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.75 / $15.40 / $25.40
| Facility | | $14.75 | $15.40 | $25.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.57 / $9.39 / $23.85
| Professional | | $6.57 | $9.39 | $23.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.76 / $29.90 / $52.57
| Facility | | $11.76 | $29.90 | $52.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.13 / $13.86 / $18.07
| Professional | | $9.13 | $13.86 | $18.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.26 / $9.15 / $24.78
| Professional | | $5.26 | $9.15 | $24.78 |