- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.26 / $29.07 / $413.56
| Facility | | $21.26 | $29.07 | $413.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.80 / $21.48 / $21.48
| Professional | | $16.80 | $21.48 | $21.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.82 / $13.82 / $13.82
| Facility | | $13.82 | $13.82 | $13.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.27 / $24.37 / $39.76
| Professional | | $15.27 | $24.37 | $39.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.34 / $56.55 / $102.92
| Facility | | $18.34 | $56.55 | $102.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.93 / $10.66 / $29.70
| Professional | | $8.93 | $10.66 | $29.70 |