- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.38 / $130.10 / $566.77
| Facility | | $8.38 | $130.10 | $566.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $30.94 / $178.60
| Professional | | $1.48 | $30.94 | $178.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.93 / $3.45 / $3.45
| Professional | | $2.93 | $3.45 | $3.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.39 / $1.39 / $1.39
| Facility | | $1.39 | $1.39 | $1.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $2.09 / $2.09
| Professional | | $1.48 | $2.09 | $2.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.48 / $1.48
| Professional | | $1.48 | $1.48 | $1.48 |