- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.41 / $144.74 / $209.70
| Facility | | $56.41 | $144.74 | $209.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.31 / $16.01 / $17.98
| Professional | | $13.31 | $16.01 | $17.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.37 / $15.81 / $49.55
| Facility | | $15.37 | $15.81 | $49.55 |
- 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
- $17.98 / $20.68 / $80.88
| Facility | | $17.98 | $20.68 | $80.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.76 / $14.65 / $20.75
| Professional | | $13.76 | $14.65 | $20.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.55 / $10.62 / $10.79
| Professional | | $7.55 | $10.62 | $10.79 |