- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.67 / $1,014.92 / $2,029.83
| Facility | | $12.67 | $1,014.92 | $2,029.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.67 / $12.67 / $12.67
| Professional | | $12.67 | $12.67 | $12.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.51 / $61.94 / $135.56
| Professional | | $13.51 | $61.94 | $135.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.45 / $28.55 / $61.90
| Facility | | $27.45 | $28.55 | $61.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.18 / $19.41 / $24.26
| Professional | | $9.18 | $19.41 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.33 / $34.33 / $34.33
| Professional | | $34.33 | $34.33 | $34.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.31 / $15.37 / $15.37
| Professional | | $8.31 | $15.37 | $15.37 |