- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.07 / $27.81 / $157.32
| Facility | | $20.07 | $27.81 | $157.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.10 / $20.07 / $20.07
| Professional | | $19.10 | $20.07 | $20.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.72 / $15.72 / $15.72
| Facility | | $15.72 | $15.72 | $15.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.39 / $28.08 / $45.16
| Professional | | $17.39 | $28.08 | $45.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.18 / $24.18 / $108.66
| Facility | | $24.18 | $24.18 | $108.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $14.51 / $33.79
| Professional | | $10.16 | $14.51 | $33.79 |