- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.82 / $56.34 / $144.66
| Facility | | $11.82 | $56.34 | $144.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.82 / $11.82 / $11.82
| Professional | | $11.82 | $11.82 | $11.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.61 / $68.92 / $157.62
| Professional | | $12.61 | $68.92 | $157.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.60 / $26.62 / $57.14
| Facility | | $25.60 | $26.62 | $57.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.60 / $18.17 / $22.72
| Professional | | $8.60 | $18.17 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.04 / $32.04 / $32.04
| Professional | | $32.04 | $32.04 | $32.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.62 / $9.66 / $14.34
| Professional | | $6.62 | $9.66 | $14.34 |