- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.86 / $65.81 / $263.91
| Facility | | $30.86 | $65.81 | $263.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.38 / $25.61 / $25.61
| Professional | | $24.38 | $25.61 | $25.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.05 / $20.05 / $20.05
| Facility | | $20.05 | $20.05 | $20.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.52 / $35.52 / $44.40
| Professional | | $16.52 | $35.52 | $44.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.45 / $56.45 / $56.45
| Facility | | $56.45 | $56.45 | $56.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.38 / $16.07 / $33.51
| Professional | | $11.38 | $16.07 | $33.51 |