- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.98 / $22.69 / $34.04
| Facility | | $19.98 | $22.69 | $34.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.41 / $25.79 / $47.83
| Professional | | $13.41 | $25.79 | $47.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.17 / $50.00 / $59.55
| Facility | | $2.17 | $50.00 | $59.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.17 / $46.46 / $115.39
| Professional | | $37.17 | $46.46 | $115.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.32 / $12.43 / $33.01
| Professional | | $9.32 | $12.43 | $33.01 |