- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $53.70 / $112.20
| Facility | | $22.39 | $53.70 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $21.88 / $44.67
| Professional | | $15.85 | $21.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $18.62 / $56.23
| Professional | | $10.23 | $18.62 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $44.67 / $213.80
| Facility | | $17.78 | $44.67 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $22.39 / $50.12
| Professional | | $10.96 | $22.39 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.31 / $10.23 / $19.50
| Facility | | $6.31 | $10.23 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $21.88 / $52.48
| Professional | | $13.18 | $21.88 | $52.48 |