- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.65 / $20.30 / $281.52
| Facility | | $14.65 | $20.30 | $281.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.94 / $14.65 / $18.35
| Professional | | $13.94 | $14.65 | $18.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.47 / $11.47 / $11.47
| Facility | | $11.47 | $11.47 | $11.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.43 / $20.65 / $32.39
| Professional | | $12.43 | $20.65 | $32.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.64 / $82.56 / $84.01
| Facility | | $17.64 | $82.56 | $84.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $10.59 / $24.20
| Professional | | $7.41 | $10.59 | $24.20 |