- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.33 / $197.42 / $329.61
| Facility | | $91.33 | $197.42 | $329.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.21 / $1.21 / $182.53
| Facility | | $1.21 | $1.21 | $182.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.17 / $18.17 / $22.72
| Professional | | $18.17 | $18.17 | $22.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.21 / $1.21 / $182.53
| Facility | | $1.21 | $1.21 | $182.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.28 / $18.17 / $22.72
| Professional | | $7.28 | $18.17 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.51 / $16.98 / $39.54
| Professional | | $14.51 | $16.98 | $39.54 |