- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.55 / $131.66 / $215.56
| Facility | | $23.55 | $131.66 | $215.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.76 / $17.53 / $17.80
| Professional | | $12.76 | $17.53 | $17.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.87 / $14.18 / $17.97
| Professional | | $3.87 | $14.18 | $17.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $13.58 / $25.41
| Facility | | $10.40 | $13.58 | $25.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $20.85 / $69.04
| Professional | | $10.40 | $20.85 | $69.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.63 / $24.54 / $29.45
| Professional | | $19.63 | $24.54 | $29.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.83 / $11.78 / $16.57
| Professional | | $8.83 | $11.78 | $16.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.66 / $9.82 / $19.27
| Professional | | $7.66 | $9.82 | $19.27 |