- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.43 / $137.08 / $150.88
| Facility | | $13.43 | $137.08 | $150.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $10.72 / $10.72
| Professional | | $10.21 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.40 / $8.40 / $8.40
| Facility | | $8.40 | $8.40 | $8.40 |
- 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
- $12.92 / $15.47 / $60.43
| Facility | | $12.92 | $15.47 | $60.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.43 / $7.75 / $18.04
| Professional | | $5.43 | $7.75 | $18.04 |