- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.35 / $71.68 / $182.38
| Facility | | $22.35 | $71.68 | $182.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.35 / $22.35 / $23.24
| Professional | | $22.35 | $22.35 | $23.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.86 / $23.84 / $112.36
| Professional | | $20.86 | $23.84 | $112.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.43 / $50.36 / $108.32
| Facility | | $48.43 | $50.36 | $108.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.37 / $38.04 / $231.89
| Professional | | $16.37 | $38.04 | $231.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.27 / $60.57 / $60.57
| Professional | | $34.27 | $60.57 | $60.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.52 / $17.88 / $43.50
| Professional | | $12.52 | $17.88 | $43.50 |