- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.07 / $36.63 / $1,130.39
| Facility | | $28.07 | $36.63 | $1,130.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $12.05 / $12.05
| Professional | | $12.05 | $12.05 | $12.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.90 / $43.41 / $160.63
| Professional | | $12.90 | $43.41 | $160.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.13 / $27.17 / $58.33
| Facility | | $26.13 | $27.17 | $58.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.80 / $18.59 / $23.23
| Professional | | $8.80 | $18.59 | $23.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.67 / $32.67 / $32.67
| Professional | | $32.67 | $32.67 | $32.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.83 / $6.75 / $14.62
| Professional | | $5.83 | $6.75 | $14.62 |