- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.83 / $94.62 / $214.97
| Facility | | $53.83 | $94.62 | $214.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.21 / $50.21 / $50.21
| Facility | | $50.21 | $50.21 | $50.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.40 / $19.16 / $43.37
| Professional | | $8.40 | $19.16 | $43.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.21 / $50.21 / $50.21
| Facility | | $50.21 | $50.21 | $50.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.40 / $19.50 / $43.37
| Professional | | $8.40 | $19.50 | $43.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.10 / $16.84 / $65.87
| Professional | | $10.10 | $16.84 | $65.87 |