- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.51 / $131.22 / $667.92
| Facility | | $24.51 | $131.22 | $667.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $19.55 / $19.55
| Professional | | $18.62 | $19.55 | $19.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.32 / $15.32 / $15.32
| Facility | | $15.32 | $15.32 | $15.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.21 / $27.26 / $36.81
| Professional | | $14.21 | $27.26 | $36.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.57 / $107.69 / $166.22
| Facility | | $23.57 | $107.69 | $166.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.81 / $13.27 / $27.65
| Professional | | $9.81 | $13.27 | $27.65 |