- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.17 / $31.25 / $291.64
| Facility | | $27.17 | $31.25 | $291.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.46 / $31.73 / $31.73
| Professional | | $21.46 | $31.73 | $31.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.66 / $17.66 / $17.66
| Facility | | $17.66 | $17.66 | $17.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.54 / $31.39 / $50.56
| Professional | | $19.54 | $31.39 | $50.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $72.27 / $131.54
| Facility | | $19.05 | $72.27 | $131.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.41 / $16.66 / $37.95
| Professional | | $11.41 | $16.66 | $37.95 |