- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.24 / $12.98 / $102.21
| Facility | | $10.24 | $12.98 | $102.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.86 / $124.00 / $1,348.66
| Facility | | $12.86 | $124.00 | $1,348.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.83 / $12.50 / $15.55
| Professional | | $9.83 | $12.50 | $15.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.03 / $20.20 / $87.12
| Facility | | $11.03 | $20.20 | $87.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.01 / $43.15 / $79.18
| Facility | | $13.01 | $43.15 | $79.18 |