- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.01 / $122.22 / $247.71
| Facility | | $22.01 | $122.22 | $247.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.01 / $22.01 / $22.01
| Professional | | $22.01 | $22.01 | $22.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.42 / $128.33 / $293.52
| Professional | | $26.42 | $128.33 | $293.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.70 / $49.61 / $107.13
| Facility | | $47.70 | $49.61 | $107.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.83 / $33.86 / $42.33
| Professional | | $25.83 | $33.86 | $42.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.66 / $59.66 / $59.66
| Professional | | $59.66 | $59.66 | $59.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.22 / $18.59 / $63.66
| Professional | | $17.22 | $18.59 | $63.66 |