- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.61 / $91.36 / $147.27
| Facility | | $29.61 | $91.36 | $147.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.71 / $12.71 / $12.71
| Professional | | $12.71 | $12.71 | $12.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $74.09 / $169.47
| Professional | | $13.55 | $74.09 | $169.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.53 / $28.63 / $61.90
| Facility | | $27.53 | $28.63 | $61.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.36 / $19.41 / $24.26
| Professional | | $9.36 | $19.41 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.43 / $34.43 / $34.43
| Professional | | $34.43 | $34.43 | $34.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.37 / $10.16 / $15.42
| Professional | | $7.37 | $10.16 | $15.42 |