- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.32 / $32.69 / $298.08
| Facility | | $15.32 | $32.69 | $298.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.10 / $12.72 / $12.72
| Professional | | $12.10 | $12.72 | $12.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.96 / $9.96 / $9.96
| Facility | | $9.96 | $9.96 | $9.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.01 / $17.35 / $28.47
| Professional | | $11.01 | $17.35 | $28.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.32 / $40.75 / $76.98
| Facility | | $15.32 | $40.75 | $76.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.43 / $9.40 / $22.98
| Professional | | $6.43 | $9.40 | $22.98 |