- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.50 / $75.70 / $109.29
| Facility | | $44.50 | $75.70 | $109.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.75 / $12.67 / $17.41
| Professional | | $10.75 | $12.67 | $17.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.44 / $12.79 / $40.10
| Facility | | $12.44 | $12.79 | $40.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.19 / $16.93 / $21.17
| Professional | | $9.19 | $16.93 | $21.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.55 / $16.73 / $65.48
| Facility | | $14.55 | $16.73 | $65.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.13 / $11.94 / $16.76
| Professional | | $11.13 | $11.94 | $16.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.11 / $8.66 / $8.73
| Professional | | $6.11 | $8.66 | $8.73 |