- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.08 / $48.02 / $93.51
| Facility | | $10.08 | $48.02 | $93.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.08 / $10.08 / $10.08
| Professional | | $10.08 | $10.08 | $10.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.75 / $58.75 / $134.33
| Professional | | $10.75 | $58.75 | $134.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.85 / $22.72 / $48.80
| Facility | | $21.85 | $22.72 | $48.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $15.69 / $19.62
| Professional | | $7.46 | $15.69 | $19.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.32 / $27.32 / $27.32
| Professional | | $27.32 | $27.32 | $27.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.64 / $8.24 / $12.23
| Professional | | $5.64 | $8.24 | $12.23 |