- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.56 / $172.71 / $172.71
| Facility | | $24.56 | $172.71 | $172.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.56 / $32.97 / $46.17
| Professional | | $24.56 | $32.97 | $46.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.82 / $70.70 / $79.23
| Professional | | $52.82 | $70.70 | $79.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.06 / $40.06 / $58.81
| Professional | | $40.06 | $40.06 | $58.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.05 / $27.37 / $63.16
| Facility | | $21.05 | $27.37 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $50.88 / $325.62
| Professional | | $21.05 | $50.88 | $325.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.74 / $46.32 / $59.65
| Professional | | $14.74 | $46.32 | $59.65 |