- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.02 / $66.36 / $98.73
| Facility | | $25.02 | $66.36 | $98.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $10.74 / $10.74
| Professional | | $10.74 | $10.74 | $10.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.46 / $57.40 / $129.53
| Professional | | $11.46 | $57.40 | $129.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.28 / $24.21 / $52.38
| Facility | | $23.28 | $24.21 | $52.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.84 / $16.52 / $20.65
| Professional | | $7.84 | $16.52 | $20.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.11 / $29.11 / $29.11
| Professional | | $29.11 | $29.11 | $29.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $8.59 / $13.03
| Professional | | $7.60 | $8.59 | $13.03 |