- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.46 / $103.88 / $187.82
| Facility | | $25.46 | $103.88 | $187.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.93 / $10.93 / $10.93
| Professional | | $10.93 | $10.93 | $10.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.66 / $63.73 / $145.77
| Professional | | $11.66 | $63.73 | $145.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.68 / $24.62 / $52.38
| Facility | | $23.68 | $24.62 | $52.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.02 / $16.93 / $21.17
| Professional | | $8.02 | $16.93 | $21.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.62 / $29.62 / $29.62
| Professional | | $29.62 | $29.62 | $29.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.55 / $9.23 / $24.85
| Professional | | $8.55 | $9.23 | $24.85 |