- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.63 / $31.71 / $325.68
| Facility | | $15.63 | $31.71 | $325.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.87 / $12.47 / $15.63
| Professional | | $11.87 | $12.47 | $15.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $9.77 / $9.77
| Facility | | $9.77 | $9.77 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.83 / $16.93 / $27.98
| Professional | | $10.83 | $16.93 | $27.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.03 / $70.31 / $96.65
| Facility | | $15.03 | $70.31 | $96.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $9.02 / $21.00
| Professional | | $6.31 | $9.02 | $21.00 |