- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.45 / $147.06 / $175.44
| Facility | | $71.45 | $147.06 | $175.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $20.94 / $32.13
| Professional | | $10.40 | $20.94 | $32.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.14 / $24.18 / $27.14
| Professional | | $18.14 | $24.18 | $27.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.63 / $13.77 / $17.30
| Professional | | $13.63 | $13.77 | $17.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.52 / $35.49 / $88.55
| Facility | | $8.52 | $35.49 | $88.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.95 / $14.40 / $20.58
| Professional | | $5.95 | $14.40 | $20.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $8.39 / $20.58
| Professional | | $5.04 | $8.39 | $20.58 |