- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.87 / $14.80 / $143.10
| Facility | | $12.87 | $14.80 | $143.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.17 / $15.03 / $15.03
| Professional | | $10.17 | $15.03 | $15.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.36 / $8.36 / $8.36
| Facility | | $8.36 | $8.36 | $8.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.24 / $14.87 / $24.05
| Professional | | $9.24 | $14.87 | $24.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.87 / $34.22 / $82.76
| Facility | | $12.87 | $34.22 | $82.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.19 / $10.30 / $17.98
| Professional | | $8.19 | $10.30 | $17.98 |