- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.08 / $555.51 / $986.89
| Facility | | $28.08 | $555.51 | $986.89 |
- 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
- $22.81 / $39.47 / $81.61
| Professional | | $22.81 | $39.47 | $81.61 |
- 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
- $10.27 / $11.46 / $32.86
| Professional | | $10.27 | $11.46 | $32.86 |