- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.83 / $177.27 / $373.38
| Facility | | $33.83 | $177.27 | $373.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.83 / $33.83 / $39.64
| Professional | | $33.83 | $33.83 | $39.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.65 / $35.65 / $111.74
| Facility | | $34.65 | $35.65 | $111.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.88 / $43.40 / $74.29
| Professional | | $20.88 | $43.40 | $74.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.54 / $46.63 / $164.23
| Facility | | $40.54 | $46.63 | $164.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.18 / $43.81 / $49.19
| Professional | | $39.18 | $43.81 | $49.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.03 / $20.05 / $24.33
| Professional | | $17.03 | $20.05 | $24.33 |