- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.98 / $351.12 / $1,053.35
| Facility | | $11.98 | $351.12 | $1,053.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.58 / $11.95 / $12.18
| Professional | | $10.58 | $11.95 | $12.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $12.34 / $19.48
| Professional | | $10.30 | $12.34 | $19.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.10 / $170.10 / $193.45
| Facility | | $170.10 | $170.10 | $193.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.84 / $12.20 / $24.31
| Professional | | $8.84 | $12.20 | $24.31 |