- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.78 / $143.13 / $143.13
| Facility | | $26.78 | $143.13 | $143.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.77 / $23.87 / $24.28
| Professional | | $22.77 | $23.87 | $24.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.03 / $31.03 / $37.22
| Facility | | $31.03 | $31.03 | $37.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.47 / $42.00 / $86.00
| Professional | | $33.47 | $42.00 | $86.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.74 / $53.74 / $53.74
| Facility | | $53.74 | $53.74 | $53.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.39 / $30.98 / $38.72
| Professional | | $16.39 | $30.98 | $38.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.25 / $15.46 / $37.40
| Professional | | $11.25 | $15.46 | $37.40 |