- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.98 / $45.71 / $173.78
| Facility | | $16.98 | $45.71 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $22.91 / $2,630.27
| Professional | | $16.98 | $22.91 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $51.29 / $57.54
| Professional | | $37.15 | $51.29 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $29.51 / $37.15
| Professional | | $29.51 | $29.51 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $30.20 / $120.23
| Facility | | $17.78 | $30.20 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $17.78 / $43.65
| Professional | | $10.72 | $17.78 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $25.70 / $43.65
| Professional | | $10.72 | $25.70 | $43.65 |