- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.26 / $61.14 / $206.60
| Facility | | $22.26 | $61.14 | $206.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.26 / $22.26 / $22.26
| Professional | | $22.26 | $22.26 | $22.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.74 / $129.80 / $296.81
| Professional | | $23.74 | $129.80 | $296.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.23 / $50.15 / $108.32
| Facility | | $48.23 | $50.15 | $108.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.25 / $34.28 / $42.85
| Professional | | $16.25 | $34.28 | $42.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.33 / $60.33 / $60.33
| Professional | | $60.33 | $60.33 | $60.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.42 / $24.04 / $50.61
| Professional | | $17.42 | $24.04 | $50.61 |