- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.84 / $52.05 / $101.33
| Facility | | $11.84 | $52.05 | $101.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.84 / $11.84 / $11.84
| Professional | | $11.84 | $11.84 | $11.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.62 / $63.66 / $145.63
| Professional | | $12.62 | $63.66 | $145.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.65 / $26.68 / $57.14
| Facility | | $25.65 | $26.68 | $57.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.60 / $18.17 / $22.72
| Professional | | $8.60 | $18.17 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.08 / $32.08 / $32.08
| Professional | | $32.08 | $32.08 | $32.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.63 / $9.22 / $14.36
| Professional | | $6.63 | $9.22 | $14.36 |