- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $46.77 / $131.83
| Facility | | $46.77 | $46.77 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $12.88 / $15.14
| Professional | | $10.00 | $12.88 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $35.48 / $107.15
| Facility | | $32.36 | $35.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.09 / $12.02 / $35.48
| Professional | | $2.09 | $12.02 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $58.88 / $81.28
| Facility | | $30.20 | $58.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $26.92
| Professional | | $21.38 | $21.38 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $32.36 / $60.26
| Professional | | $18.62 | $32.36 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $11.22 / $28.18
| Professional | | $7.76 | $11.22 | $28.18 |