- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.79 / $37.29 / $102.09
| Facility | | $12.79 | $37.29 | $102.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $11.12 / $14.40
| Professional | | $10.61 | $11.12 | $14.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.37 / $12.68 / $86.40
| Professional | | $11.37 | $12.68 | $86.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.26 / $81.30 / $116.06
| Professional | | $14.26 | $81.30 | $116.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.95 / $15.87 / $15.87
| Professional | | $14.95 | $15.87 | $15.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.04 / $15.87 / $36.15
| Professional | | $11.04 | $15.87 | $36.15 |