- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.47 / $48.97 / $113.63
| Facility | | $26.47 | $48.97 | $113.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.47 / $27.53 / $31.41
| Professional | | $26.47 | $27.53 | $31.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.17 / $15.62 / $35.29
| Professional | | $8.17 | $15.62 | $35.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.61 / $48.24 / $110.62
| Facility | | $10.61 | $48.24 | $110.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.40 / $16.11 / $50.59
| Professional | | $7.40 | $16.11 | $50.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.46 / $167.63 / $167.63
| Facility | | $56.46 | $167.63 | $167.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.87 / $14.82 / $35.29
| Professional | | $7.87 | $14.82 | $35.29 |