- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.59 / $104.10 / $397.37
| Facility | | $29.59 | $104.10 | $397.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.23 / $12.23 / $12.23
| Professional | | $12.23 | $12.23 | $12.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.04 / $71.30 / $163.10
| Professional | | $13.04 | $71.30 | $163.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.50 / $27.56 / $59.52
| Facility | | $26.50 | $27.56 | $59.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.99 / $18.59 / $23.23
| Professional | | $8.99 | $18.59 | $23.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.13 / $33.13 / $33.13
| Professional | | $33.13 | $33.13 | $33.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.85 / $10.00 / $14.83
| Professional | | $6.85 | $10.00 | $14.83 |