- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.86 / $73.03 / $308.29
| Facility | | $3.86 | $73.03 | $308.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.93 / $19.62 / $19.62
| Professional | | $13.93 | $19.62 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.92 / $10.92 / $10.92
| Facility | | $10.92 | $10.92 | $10.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.08 / $19.41 / $31.41
| Professional | | $12.08 | $19.41 | $31.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.80 / $41.35 / $141.40
| Facility | | $16.80 | $41.35 | $141.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.06 / $10.08 / $23.47
| Professional | | $7.06 | $10.08 | $23.47 |