- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $101.53 / $314.64
| Facility | | $16.05 | $101.53 | $314.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.69 / $13.33 / $13.33
| Professional | | $12.69 | $13.33 | $13.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.44 / $10.44 / $10.44
| Facility | | $10.44 | $10.44 | $10.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.54 / $18.59 / $29.94
| Professional | | $11.54 | $18.59 | $29.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $42.72 / $75.12
| Facility | | $16.05 | $42.72 | $75.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $9.64 / $22.44
| Professional | | $6.75 | $9.64 | $22.44 |