- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $110.64 / $207.81
| Facility | | $22.39 | $110.64 | $207.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $22.39 / $22.39
| Professional | | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $130.55 / $298.58
| Professional | | $23.88 | $130.55 | $298.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.50 / $50.44 / $108.32
| Facility | | $48.50 | $50.44 | $108.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.44 / $34.28 / $42.85
| Professional | | $16.44 | $34.28 | $42.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.68 / $60.68 / $60.68
| Professional | | $60.68 | $60.68 | $60.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.52 / $18.30 / $27.16
| Professional | | $17.52 | $18.30 | $27.16 |