- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.08 / $65.42 / $364.86
| Facility | | $28.08 | $65.42 | $364.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.08 / $28.08 / $28.08
| Professional | | $28.08 | $28.08 | $28.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $66.31 / $145.15
| Professional | | $11.48 | $66.31 | $145.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $1.53 / $108.32
| Facility | | $1.48 | $1.53 | $108.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.97 / $26.85 / $33.56
| Professional | | $17.97 | $26.85 | $33.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.20 / $72.20 / $72.20
| Professional | | $72.20 | $72.20 | $72.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.22 / $15.10 / $32.86
| Professional | | $9.22 | $15.10 | $32.86 |