- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.54 / $132.30 / $157.32
| Facility | | $13.54 | $132.30 | $157.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $15.82 / $15.82
| Professional | | $10.70 | $15.82 | $15.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.80 / $8.80 / $8.80
| Facility | | $8.80 | $8.80 | $8.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $15.69 / $25.52
| Professional | | $9.77 | $15.69 | $25.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.54 / $36.02 / $63.68
| Facility | | $13.54 | $36.02 | $63.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $8.31 / $18.93
| Professional | | $5.69 | $8.31 | $18.93 |