- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.57 / $97.52 / $134.10
| Facility | | $14.57 | $97.52 | $134.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.51 / $17.01 / $17.01
| Professional | | $11.51 | $17.01 | $17.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.47 / $9.47 / $9.47
| Facility | | $9.47 | $9.47 | $9.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $16.93 / $27.00
| Professional | | $10.48 | $16.93 | $27.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.76 / $68.15 / $118.56
| Facility | | $38.76 | $68.15 | $118.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.12 / $8.74 / $20.36
| Professional | | $6.12 | $8.74 | $20.36 |