- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $36.31 / $218.78
| Facility | | $14.13 | $36.31 | $218.78 |
- 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
- $16.98 / $57.54 / $114.82
| Facility | | $16.98 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $10.47 / $25.70
| Professional | | $5.25 | $10.47 | $25.70 |