- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.00 / $143.40 / $218.26
| Facility | | $28.00 | $143.40 | $218.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.11 / $29.27 / $51.66
| Professional | | $20.11 | $29.27 | $51.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.73 / $12.73 / $12.73
| Professional | | $12.73 | $12.73 | $12.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.64 / $43.64 / $43.64
| Facility | | $43.64 | $43.64 | $43.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.64 / $43.64 / $43.64
| Professional | | $43.64 | $43.64 | $43.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.54 / $26.34 / $50.79
| Facility | | $16.54 | $26.34 | $50.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.63 / $16.62 / $36.65
| Professional | | $11.63 | $16.62 | $36.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.73 / $12.73 / $25.45
| Facility | | $12.73 | $12.73 | $25.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.69 / $15.27 / $48.27
| Professional | | $10.69 | $15.27 | $48.27 |