- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.49 / $18.62 / $245.47
| Facility | | $13.49 | $18.62 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $15.85 / $48.98
| Professional | | $12.02 | $15.85 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $10.47
| Facility | | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $18.62 / $30.20
| Professional | | $11.48 | $18.62 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $42.66 / $77.62
| Facility | | $16.22 | $42.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $10.96 / $24.55
| Professional | | $6.76 | $10.96 | $24.55 |