- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.86 / $21.03 / $21.03
| Professional | | $15.86 | $21.03 | $21.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.42 / $214.97 / $253.52
| Facility | | $93.42 | $214.97 | $253.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.64 / $18.64 / $18.64
| Professional | | $18.64 | $18.64 | $18.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.16 / $20.16 / $256.70
| Facility | | $20.16 | $20.16 | $256.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.88 / $26.85 / $40.01
| Professional | | $17.88 | $26.85 | $40.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.16 / $20.16 / $256.70
| Facility | | $20.16 | $20.16 | $256.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.46 / $21.48 / $40.01
| Professional | | $13.46 | $21.48 | $40.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $10.10 / $32.68
| Professional | | $6.30 | $10.10 | $32.68 |