- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.68 / $117.71 / $305.94
| Facility | | $12.68 | $117.71 | $305.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.68 / $12.68 / $12.68
| Professional | | $12.68 | $12.68 | $12.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.53 / $73.93 / $169.13
| Professional | | $13.53 | $73.93 | $169.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.48 / $28.57 / $61.90
| Facility | | $27.48 | $28.57 | $61.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.18 / $19.41 / $24.26
| Professional | | $9.18 | $19.41 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.36 / $34.36 / $34.36
| Professional | | $34.36 | $34.36 | $34.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.10 / $10.37 / $15.39
| Professional | | $7.10 | $10.37 | $15.39 |