- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.56 / $77.48 / $162.46
| Facility | | $33.56 | $77.48 | $162.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.33 / $23.58 / $32.92
| Professional | | $14.33 | $23.58 | $32.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.50 / $15.95 / $49.98
| Facility | | $15.50 | $15.95 | $49.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.38 / $20.65 / $25.81
| Professional | | $11.38 | $20.65 | $25.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.14 / $20.86 / $81.65
| Facility | | $18.14 | $20.86 | $81.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.89 / $14.65 / $20.75
| Professional | | $13.89 | $14.65 | $20.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.62 / $10.38 / $10.88
| Professional | | $7.62 | $10.38 | $10.88 |