- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.06 / $16.39 / $25.57
| Facility | | $12.06 | $16.39 | $25.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.06 / $12.06 / $14.47
| Professional | | $12.06 | $12.06 | $14.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.54 / $13.91 / $23.13
| Facility | | $3.54 | $13.91 | $23.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.66 / $5.32 / $7.58
| Professional | | $3.66 | $5.32 | $7.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.28 / $51.96 / $103.46
| Facility | | $3.28 | $51.96 | $103.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.06 / $12.06 / $14.47
| Facility | | $12.06 | $12.06 | $14.47 |