- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $144.54 / $194.98
| Facility | | $12.02 | $144.54 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $10.00 / $36.31
| Professional | | $8.91 | $10.00 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.76 / $7.76 / $7.76
| Facility | | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $13.49 / $22.39
| Professional | | $8.51 | $13.49 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $30.20 / $57.54
| Facility | | $12.02 | $30.20 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $7.41 / $18.20
| Professional | | $5.01 | $7.41 | $18.20 |