- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.47 / $38.47 / $314.02
| Facility | | $38.47 | $38.47 | $314.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.47 / $38.47 / $40.02
| Professional | | $38.47 | $38.47 | $40.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.05 / $46.18 / $254.03
| Professional | | $41.05 | $46.18 | $254.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.38 / $86.71 / $186.89
| Facility | | $83.38 | $86.71 | $186.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.86 / $81.01 / $399.07
| Professional | | $35.86 | $81.01 | $399.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.01 / $104.30 / $104.30
| Professional | | $59.01 | $104.30 | $104.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.55 / $46.69 / $100.73
| Professional | | $21.55 | $46.69 | $100.73 |