- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.71 / $138.35 / $218.76
| Facility | | $19.71 | $138.35 | $218.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.98 / $22.16 / $22.16
| Professional | | $14.98 | $22.16 | $22.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.32 / $12.32 / $12.32
| Facility | | $12.32 | $12.32 | $12.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.68 / $21.89 / $35.34
| Professional | | $13.68 | $21.89 | $35.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.96 / $50.43 / $88.69
| Facility | | $18.96 | $50.43 | $88.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.96 / $11.38 / $26.51
| Professional | | $7.96 | $11.38 | $26.51 |