- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.37 / $125.51 / $256.50
| Facility | | $17.37 | $125.51 | $256.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.20 / $13.87 / $17.37
| Professional | | $13.20 | $13.87 | $17.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.86 / $10.86 / $10.86
| Facility | | $10.86 | $10.86 | $10.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.08 / $19.41 / $31.41
| Professional | | $12.08 | $19.41 | $31.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.71 / $41.12 / $49.65
| Facility | | $16.71 | $41.12 | $49.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.02 / $10.02 / $23.35
| Professional | | $7.02 | $10.02 | $23.35 |