- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.92 / $132.77 / $232.35
| Facility | | $33.92 | $132.77 | $232.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.68 / $23.92 / $33.92
| Professional | | $17.68 | $23.92 | $33.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.89 / $23.55 / $73.80
| Facility | | $22.89 | $23.55 | $73.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.82 / $30.98 / $38.72
| Professional | | $16.82 | $30.98 | $38.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.79 / $30.81 / $120.57
| Facility | | $26.79 | $30.81 | $120.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.50 / $21.71 / $30.72
| Professional | | $20.50 | $21.71 | $30.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.25 / $15.93 / $16.07
| Professional | | $11.25 | $15.93 | $16.07 |