- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.44 / $80.11 / $183.11
| Facility | | $22.44 | $80.11 | $183.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.44 / $22.44 / $22.44
| Professional | | $22.44 | $22.44 | $22.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.94 / $98.03 / $224.13
| Professional | | $23.94 | $98.03 | $224.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.63 / $50.57 / $108.32
| Facility | | $48.63 | $50.57 | $108.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.22 / $34.28 / $42.85
| Professional | | $26.22 | $34.28 | $42.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.82 / $60.82 / $60.82
| Professional | | $60.82 | $60.82 | $60.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.57 / $13.74 / $27.23
| Professional | | $12.57 | $13.74 | $27.23 |