- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.47 / $71.68 / $167.02
| Facility | | $20.47 | $71.68 | $167.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.47 / $20.47 / $21.29
| Professional | | $20.47 | $20.47 | $21.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.83 / $22.00 / $112.36
| Professional | | $21.83 | $22.00 | $112.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.35 / $46.12 / $98.80
| Facility | | $44.35 | $46.12 | $98.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.37 / $34.84 / $213.02
| Professional | | $16.37 | $34.84 | $213.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.38 / $55.47 / $55.47
| Professional | | $31.38 | $55.47 | $55.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.46 / $16.37 / $43.50
| Professional | | $11.46 | $16.37 | $43.50 |