- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.79 / $249.62 / $517.32
| Facility | | $14.79 | $249.62 | $517.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.35 / $16.01 / $55.20
| Professional | | $3.35 | $16.01 | $55.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.28 / $14.28 / $14.28
| Professional | | $14.28 | $14.28 | $14.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.31 / $14.79 / $25.88
| Facility | | $13.31 | $14.79 | $25.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.62 / $27.18 / $31.06
| Professional | | $25.62 | $27.18 | $31.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $24.38 / $24.38
| Professional | | $20.72 | $24.38 | $24.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.13 / $22.34 / $30.87
| Professional | | $18.13 | $22.34 | $30.87 |