- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.01 / $65.28 / $114.32
| Facility | | $14.01 | $65.28 | $114.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.01 / $14.01 / $14.01
| Professional | | $14.01 | $14.01 | $14.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $47.48 / $186.94
| Professional | | $15.00 | $47.48 | $186.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.35 / $31.56 / $67.84
| Facility | | $30.35 | $31.56 | $67.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.33 / $21.48 / $26.85
| Professional | | $10.33 | $21.48 | $26.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.97 / $37.97 / $37.97
| Professional | | $37.97 | $37.97 | $37.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.42 / $22.42 / $22.42
| Facility | | $22.42 | $22.42 | $22.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.66 / $9.51 / $17.00
| Professional | | $6.66 | $9.51 | $17.00 |