- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.44 / $156.80 / $282.14
| Facility | | $17.44 | $156.80 | $282.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.91 / $19.60 / $19.60
| Professional | | $13.91 | $19.60 | $19.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.90 / $10.90 / $10.90
| Facility | | $10.90 | $10.90 | $10.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.08 / $19.41 / $31.41
| Professional | | $12.08 | $19.41 | $31.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.77 / $44.61 / $208.32
| Facility | | $16.77 | $44.61 | $208.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.04 / $10.06 / $23.44
| Professional | | $7.04 | $10.06 | $23.44 |