- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.61 / $70.59 / $147.63
| Facility | | $43.61 | $70.59 | $147.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.44 / $6.77 / $12.70
| Professional | | $5.44 | $6.77 | $12.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.70 / $15.66 / $17.48
| Professional | | $11.70 | $15.66 | $17.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.09 / $9.18 / $11.54
| Professional | | $9.09 | $9.18 | $11.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.23 / $58.65 / $97.48
| Facility | | $12.23 | $58.65 | $97.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $5.44 / $19.23
| Professional | | $3.89 | $5.44 | $19.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.26 / $5.44 / $13.33
| Professional | | $3.26 | $5.44 | $13.33 |