- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $26.92 / $331.13
| Facility | | $10.96 | $26.92 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $10.96 / $15.14
| Professional | | $7.08 | $10.96 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $14.13 / $28.84
| Professional | | $7.41 | $14.13 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Professional | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $11.48 / $17.38
| Professional | | $9.77 | $11.48 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $20.89 / $63.10
| Professional | | $14.13 | $20.89 | $63.10 |