- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.27 / $163.80 / $345.92
| Facility | | $14.27 | $163.80 | $345.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.85 / $11.40 / $11.40
| Professional | | $10.85 | $11.40 | $11.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.92 / $8.92 / $8.92
| Facility | | $8.92 | $8.92 | $8.92 |
- 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
- $13.73 / $64.22 / $204.72
| Facility | | $13.73 | $64.22 | $204.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $8.24 / $20.60
| Professional | | $5.77 | $8.24 | $20.60 |