- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.13 / $52.46 / $102.86
| Facility | | $42.13 | $52.46 | $102.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.13 / $42.13 / $54.62
| Professional | | $42.13 | $42.13 | $54.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.88 / $16.84 / $22.66
| Facility | | $13.88 | $16.84 | $22.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.76 / $33.36 / $38.57
| Professional | | $31.76 | $33.36 | $38.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.43 / $43.46 / $3,138.00
| Facility | | $33.43 | $43.46 | $3,138.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.10 / $59.10 / $73.88
| Professional | | $59.10 | $59.10 | $73.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $17.73 / $25.72
| Professional | | $15.77 | $17.73 | $25.72 |