- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.98 / $25.54 / $352.36
| Facility | | $11.98 | $25.54 | $352.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.46 / $10.84 / $10.84
| Professional | | $9.46 | $10.84 | $10.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.79 / $7.79 / $7.79
| Facility | | $7.79 | $7.79 | $7.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $13.63 / $22.58
| Professional | | $8.52 | $13.63 | $22.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.98 / $51.63 / $78.58
| Facility | | $11.98 | $51.63 | $78.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.03 / $7.19 / $16.76
| Professional | | $5.03 | $7.19 | $16.76 |