- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.88 / $69.42 / $121.20
| Facility | | $37.88 | $69.42 | $121.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.76 / $26.77 / $40.40
| Professional | | $26.76 | $26.77 | $40.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.83 / $35.29 / $82.49
| Facility | | $32.83 | $35.29 | $82.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.48 / $51.31 / $72.28
| Professional | | $22.48 | $51.31 | $72.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.78 / $39.77 / $239.88
| Facility | | $36.78 | $39.77 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.21 / $28.86 / $63.13
| Professional | | $21.21 | $28.86 | $63.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.21 / $25.25 / $32.83
| Professional | | $21.21 | $25.25 | $32.83 |