- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.94 / $115.30 / $326.60
| Facility | | $16.94 | $115.30 | $326.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.06 / $19.78 / $19.78
| Professional | | $14.06 | $19.78 | $19.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.01 / $11.01 / $11.01
| Facility | | $11.01 | $11.01 | $11.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.08 / $19.41 / $31.90
| Professional | | $12.08 | $19.41 | $31.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.83 / $45.06 / $108.93
| Facility | | $6.83 | $45.06 | $108.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.50 / $16.50 / $16.50
| Professional | | $16.50 | $16.50 | $16.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.11 / $10.16 / $23.67
| Professional | | $7.11 | $10.16 | $23.67 |