- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.07 / $85.68 / $159.13
| Facility | | $20.07 | $85.68 | $159.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.07 / $21.48 / $21.48
| Professional | | $20.07 | $21.48 | $21.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.55 / $12.55 / $12.55
| Facility | | $12.55 | $12.55 | $12.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $22.13 / $27.66
| Professional | | $10.16 | $22.13 | $27.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.30 / $45.25 / $126.66
| Facility | | $19.30 | $45.25 | $126.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.11 / $11.28 / $25.70
| Professional | | $8.11 | $11.28 | $25.70 |