- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $25.12 / $144.54
| Facility | | $18.20 | $25.12 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $25.12 / $81.28
| Professional | | $16.98 | $25.12 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $52.48 / $61.66
| Professional | | $39.81 | $52.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $31.62 / $39.81
| Professional | | $31.62 | $31.62 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $32.36 / $128.82
| Facility | | $19.05 | $32.36 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $13.49 / $45.71
| Professional | | $11.48 | $13.49 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $24.55 / $38.90
| Professional | | $11.48 | $24.55 | $38.90 |