- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.41 / $203.26 / $388.17
| Facility | | $20.41 | $203.26 | $388.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.51 / $16.29 / $41.86
| Professional | | $15.51 | $16.29 | $41.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.76 / $12.76 / $12.76
| Facility | | $12.76 | $12.76 | $12.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.03 / $22.72 / $36.81
| Professional | | $14.03 | $22.72 | $36.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.63 / $52.22 / $286.39
| Facility | | $19.63 | $52.22 | $286.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.24 / $11.78 / $27.42
| Professional | | $8.24 | $11.78 | $27.42 |