- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.63 / $34.56 / $126.08
| Facility | | $18.63 | $34.56 | $126.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.80 / $13.45 / $13.45
| Professional | | $12.80 | $13.45 | $13.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.53 / $10.53 / $10.53
| Facility | | $10.53 | $10.53 | $10.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.41 / $18.59 / $24.54
| Professional | | $9.41 | $18.59 | $24.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.54 / $8.09 / $18.43
| Professional | | $6.54 | $8.09 | $18.43 |