- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.57 / $31.07 / $187.51
| Facility | | $14.57 | $31.07 | $187.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.51 / $12.09 / $12.09
| Professional | | $11.51 | $12.09 | $12.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.47 / $9.47 / $9.47
| Facility | | $9.47 | $9.47 | $9.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $16.93 / $27.00
| Professional | | $10.48 | $16.93 | $27.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.57 / $38.76 / $87.10
| Facility | | $14.57 | $38.76 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.12 / $8.74 / $20.34
| Professional | | $6.12 | $8.74 | $20.34 |