- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.84 / $58.50 / $136.83
| Facility | | $39.84 | $58.50 | $136.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.65 / $6.14 / $8.27
| Professional | | $5.65 | $6.14 | $8.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $13.88 / $15.50
| Professional | | $10.38 | $13.88 | $15.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.85 / $7.93 / $9.97
| Professional | | $7.85 | $7.93 | $9.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.34 / $43.70 / $87.36
| Facility | | $10.34 | $43.70 | $87.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.45 / $8.27 / $17.05
| Professional | | $3.45 | $8.27 | $17.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.89 / $7.03 / $11.81
| Professional | | $2.89 | $7.03 | $11.81 |