- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.36 / $82.26 / $576.27
| Facility | | $44.36 | $82.26 | $576.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.47 / $32.01 / $32.01
| Professional | | $30.47 | $32.01 | $32.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.07 / $25.07 / $25.07
| Facility | | $25.07 | $25.07 | $25.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.19 / $44.19 / $55.24
| Professional | | $44.19 | $44.19 | $55.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.57 / $71.65 / $363.75
| Facility | | $38.57 | $71.65 | $363.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.50 / $18.51 / $38.57
| Professional | | $13.50 | $18.51 | $38.57 |