- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.88 / $32.09 / $1,285.46
| Facility | | $8.88 | $32.09 | $1,285.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.79 / $10.79 / $12.06
| Professional | | $10.79 | $10.79 | $12.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $29.96 / $29.96
| Professional | | $25.47 | $29.96 | $29.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.37 / $11.37 / $11.37
| Facility | | $11.37 | $11.37 | $11.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $12.05 / $17.05
| Professional | | $12.05 | $12.05 | $17.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.06 / $12.06 / $12.06
| Professional | | $12.06 | $12.06 | $12.06 |