- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.53 / $33.88 / $501.30
| Facility | | $16.53 | $33.88 | $501.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.38 / $14.06 / $14.06
| Professional | | $13.38 | $14.06 | $14.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.01 / $11.01 / $11.01
| Facility | | $11.01 | $11.01 | $11.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.08 / $19.41 / $31.90
| Professional | | $12.08 | $19.41 | $31.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.94 / $45.06 / $108.93
| Facility | | $16.94 | $45.06 | $108.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.11 / $10.16 / $23.67
| Professional | | $7.11 | $10.16 | $23.67 |