- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.45 / $89.02 / $137.32
| Facility | | $48.45 | $89.02 | $137.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.69 / $5.23 / $6.01
| Professional | | $4.69 | $5.23 | $6.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $12.36
| Facility | | $10.30 | $10.30 | $12.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.51 / $9.30 / $19.00
| Professional | | $7.51 | $9.30 | $19.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.86 / $11.86 / $11.86
| Facility | | $11.86 | $11.86 | $11.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.64 / $7.02 / $8.77
| Professional | | $3.64 | $7.02 | $8.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $3.47 / $8.38
| Professional | | $2.52 | $3.47 | $8.38 |