- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.83 / $148.08 / $508.96
| Facility | | $12.83 | $148.08 | $508.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.19 / $11.67 / $14.68
| Professional | | $11.19 | $11.67 | $14.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.78 / $0.91
| Facility | | $0.02 | $0.78 | $0.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $81.16 / $81.16
| Facility | | $40.00 | $81.16 | $81.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.27 / $10.47 / $22.35
| Professional | | $9.27 | $10.47 | $22.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.41 / $13.45 / $17.73
| Professional | | $9.41 | $13.45 | $17.73 |