- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.80 / $100.04 / $165.98
| Facility | | $81.80 | $100.04 | $165.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.86 / $14.78 / $22.52
| Professional | | $11.86 | $14.78 | $22.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.16 / $34.13 / $38.31
| Professional | | $28.16 | $34.13 | $38.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.41 / $19.61 / $24.65
| Professional | | $19.41 | $19.61 | $24.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $68.68 / $137.47
| Facility | | $14.13 | $68.68 | $137.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.47 / $11.85 / $41.94
| Professional | | $8.47 | $11.85 | $41.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.11 / $11.85 / $29.05
| Professional | | $7.11 | $11.85 | $29.05 |