- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.51 / $39.86 / $134.66
| Facility | | $14.51 | $39.86 | $134.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.51 / $14.51 / $14.51
| Professional | | $14.51 | $14.51 | $14.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.48 / $84.64 / $193.51
| Professional | | $15.48 | $84.64 | $193.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.45 / $32.71 / $70.23
| Facility | | $31.45 | $32.71 | $70.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.52 / $22.30 / $27.88
| Professional | | $10.52 | $22.30 | $27.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.33 / $39.33 / $39.33
| Professional | | $39.33 | $39.33 | $39.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $11.87 / $17.61
| Professional | | $8.13 | $11.87 | $17.61 |