- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.38 / $60.26 / $141.25
| Facility | | $17.38 | $60.26 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $14.13 / $51.29
| Professional | | $12.88 | $14.13 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Facility | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $19.95 / $31.62
| Professional | | $12.30 | $19.95 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.38 / $17.38 / $89.13
| Facility | | $17.38 | $17.38 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $10.23 / $25.70
| Professional | | $6.31 | $10.23 | $25.70 |