- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.83 / $39.50 / $169.61
| Facility | | $10.83 | $39.50 | $169.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.36 / $21.62 / $21.62
| Professional | | $15.36 | $21.62 | $21.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.04 / $12.04 / $12.04
| Facility | | $12.04 | $12.04 | $12.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.32 / $21.06 / $34.85
| Professional | | $13.32 | $21.06 | $34.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.52 / $49.26 / $123.85
| Facility | | $18.52 | $49.26 | $123.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.78 / $11.11 / $25.88
| Professional | | $7.78 | $11.11 | $25.88 |