- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.36 / $199.92 / $241.56
| Facility | | $17.36 | $199.92 | $241.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.06 / $12.25 / $15.78
| Professional | | $9.06 | $12.25 | $15.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.73 / $12.06 / $37.81
| Facility | | $11.73 | $12.06 | $37.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.57 / $15.69 / $19.62
| Professional | | $8.57 | $15.69 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.72 / $15.78 / $61.72
| Facility | | $13.72 | $15.78 | $61.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.50 / $11.12 / $15.96
| Professional | | $10.50 | $11.12 | $15.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.76 / $5.76 / $8.23
| Professional | | $5.76 | $5.76 | $8.23 |