- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.52 / $71.68 / $183.78
| Facility | | $22.52 | $71.68 | $183.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.52 / $22.52 / $23.42
| Professional | | $22.52 | $22.52 | $23.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.02 / $24.02 / $112.36
| Professional | | $21.02 | $24.02 | $112.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.80 / $50.75 / $109.51
| Facility | | $48.80 | $50.75 | $109.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.37 / $38.51 / $234.59
| Professional | | $16.37 | $38.51 | $234.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.53 / $61.04 / $61.04
| Professional | | $34.53 | $61.04 | $61.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.41 / $18.02 / $43.50
| Professional | | $12.41 | $18.02 | $43.50 |