- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.41 / $212.90 / $378.37
| Facility | | $69.41 | $212.90 | $378.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.11 / $27.01 / $27.01
| Professional | | $23.11 | $27.01 | $27.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.35 / $21.35 / $21.35
| Facility | | $21.35 | $21.35 | $21.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.37 / $26.85 / $33.56
| Professional | | $11.37 | $26.85 | $33.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.10 / $103.98 / $852.61
| Facility | | $30.10 | $103.98 | $852.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.39 / $12.64 / $19.80
| Professional | | $7.39 | $12.64 | $19.80 |