- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $54.95 / $295.12
| Facility | | $30.20 | $54.95 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $30.20 / $63.10
| Professional | | $20.42 | $30.20 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $72.44 / $81.28
| Professional | | $54.95 | $72.44 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $47.86 / $75.86
| Professional | | $28.18 | $47.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $57.54
| Facility | | $30.20 | $47.86 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $52.48 / $204.17
| Professional | | $28.84 | $52.48 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $46.77 / $72.44
| Professional | | $28.84 | $46.77 | $72.44 |