- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.04 / $102.19 / $102.19
| Facility | | $14.04 | $102.19 | $102.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.04 / $18.85 / $26.67
| Professional | | $14.04 | $18.85 | $26.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.19 / $40.40 / $45.11
| Professional | | $30.19 | $40.40 | $45.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.13 / $23.13 / $33.95
| Professional | | $23.13 | $23.13 | $33.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.03 / $18.85 / $146.52
| Facility | | $12.03 | $18.85 | $146.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.03 / $29.07 / $166.43
| Professional | | $12.03 | $29.07 | $166.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.42 / $24.06 / $34.39
| Professional | | $8.42 | $24.06 | $34.39 |