- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.25 / $87.40 / $289.80
| Facility | | $14.25 | $87.40 | $289.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.32 / $20.94 / $31.41
| Professional | | $10.32 | $20.94 | $31.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.00 / $15.33 / $41.52
| Facility | | $12.00 | $15.33 | $41.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.92 / $7.20 / $14.40
| Professional | | $5.92 | $7.20 | $14.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.41 / $20.09 / $40.20
| Facility | | $8.41 | $20.09 | $40.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.63 / $13.63 / $17.62
| Professional | | $7.63 | $13.63 | $17.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $7.20 / $16.78
| Professional | | $5.04 | $7.20 | $16.78 |