- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.64 / $86.78 / $264.81
| Facility | | $10.64 | $86.78 | $264.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.64 / $10.64 / $10.64
| Professional | | $10.64 | $10.64 | $10.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.34 / $62.01 / $141.80
| Professional | | $11.34 | $62.01 | $141.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.05 / $23.97 / $51.19
| Facility | | $23.05 | $23.97 | $51.19 |
- 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
- $28.82 / $28.82 / $28.82
| Professional | | $28.82 | $28.82 | $28.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.96 / $8.69 / $12.90
| Professional | | $5.96 | $8.69 | $12.90 |