- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.16 / $101.29 / $140.21
| Facility | | $29.16 | $101.29 | $140.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $12.05 / $12.05
| Professional | | $12.05 | $12.05 | $12.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.25 / $48.17 / $120.01
| Professional | | $11.25 | $48.17 | $120.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.13 / $27.17 / $58.33
| Facility | | $26.13 | $27.17 | $58.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.80 / $18.59 / $23.23
| Professional | | $8.80 | $18.59 | $23.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.67 / $32.67 / $32.67
| Professional | | $32.67 | $32.67 | $32.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $10.82 / $14.62
| Professional | | $6.75 | $10.82 | $14.62 |