- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.32 / $127.79 / $1,008.53
| Facility | | $18.32 | $127.79 | $1,008.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.32 / $18.32 / $18.32
| Professional | | $18.32 | $18.32 | $18.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.30 / $18.82 / $59.01
| Facility | | $18.30 | $18.82 | $59.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.56 / $25.65 / $41.07
| Professional | | $13.56 | $25.65 | $41.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.42 / $24.63 / $96.39
| Facility | | $21.42 | $24.63 | $96.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.53 / $22.99 / $25.83
| Professional | | $20.53 | $22.99 | $25.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.85 / $18.76 / $38.56
| Professional | | $12.85 | $18.76 | $38.56 |