- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.56 / $18.79 / $258.52
| Facility | | $13.56 | $18.79 | $258.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.91 / $13.56 / $13.56
| Professional | | $12.91 | $13.56 | $13.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.62 / $10.62 / $10.62
| Facility | | $10.62 | $10.62 | $10.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.72 / $19.00 / $30.43
| Professional | | $11.72 | $19.00 | $30.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.46 / $43.46 / $68.04
| Facility | | $43.46 | $43.46 | $68.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.79 / $8.10 / $22.83
| Professional | | $6.79 | $8.10 | $22.83 |