- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.55 / $69.31 / $135.06
| Facility | | $14.55 | $69.31 | $135.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.55 / $14.55 / $14.55
| Professional | | $14.55 | $14.55 | $14.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.52 / $84.85 / $194.06
| Professional | | $15.52 | $84.85 | $194.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.53 / $32.79 / $70.23
| Facility | | $31.53 | $32.79 | $70.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.71 / $22.30 / $27.88
| Professional | | $10.71 | $22.30 | $27.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.43 / $39.43 / $39.43
| Professional | | $39.43 | $39.43 | $39.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $15.71 / $17.64
| Professional | | $11.39 | $15.71 | $17.64 |