- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.00 / $41.70 / $224.88
| Facility | | $6.00 | $41.70 | $224.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.53 / $32.07 / $32.07
| Professional | | $26.53 | $32.07 | $32.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.65 / $46.06 / $51.66
| Facility | | $34.65 | $46.06 | $51.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.53 / $29.33 / $48.48
| Professional | | $20.53 | $29.33 | $48.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.76 / $60.79 / $106.87
| Facility | | $23.76 | $60.79 | $106.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.43 / $28.16 / $56.27
| Professional | | $18.43 | $28.16 | $56.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.40 / $21.35 / $51.44
| Professional | | $8.40 | $21.35 | $51.44 |