- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.32 / $17.62 / $208.47
| Facility | | $15.32 | $17.62 | $208.47 |
- 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 / $15.32 / $37.71
| Facility | | $15.32 | $15.32 | $37.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.43 / $9.19 / $22.98
| Professional | | $6.43 | $9.19 | $22.98 |