- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.61 / $127.36 / $510.78
| Facility | | $15.61 | $127.36 | $510.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $15.61 / $15.61
| Professional | | $15.61 | $15.61 | $15.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.64 / $90.99 / $208.10
| Professional | | $16.64 | $90.99 | $208.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.83 / $35.18 / $76.18
| Facility | | $33.83 | $35.18 | $76.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.47 / $23.95 / $29.94
| Professional | | $11.47 | $23.95 | $29.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.30 / $42.30 / $42.30
| Professional | | $42.30 | $42.30 | $42.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.21 / $14.01 / $18.94
| Professional | | $12.21 | $14.01 | $18.94 |