- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.32 / $43.35 / $310.50
| Facility | | $20.32 | $43.35 | $310.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.05 / $16.87 / $16.87
| Professional | | $16.05 | $16.87 | $16.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.21 / $13.21 / $13.21
| Facility | | $13.21 | $13.21 | $13.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.56 / $23.54 / $37.79
| Professional | | $14.56 | $23.54 | $37.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.32 / $54.05 / $98.37
| Facility | | $20.32 | $54.05 | $98.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $12.19 / $28.39
| Professional | | $8.52 | $12.19 | $28.39 |