- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.50 / $18.70 / $272.32
| Facility | | $13.50 | $18.70 | $272.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.85 / $13.50 / $16.91
| Professional | | $12.85 | $13.50 | $16.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.57 / $10.57 / $10.57
| Facility | | $10.57 | $10.57 | $10.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.72 / $18.59 / $30.43
| Professional | | $11.72 | $18.59 | $30.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.26 / $43.25 / $78.72
| Facility | | $16.26 | $43.25 | $78.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $9.76 / $22.72
| Professional | | $6.83 | $9.76 | $22.72 |