- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $60.26 / $190.55
| Facility | | $19.05 | $60.26 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $25.12 / $81.28
| Professional | | $19.05 | $25.12 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $52.48 / $61.66
| Professional | | $36.31 | $52.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $31.62 / $40.74
| Professional | | $31.62 | $31.62 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $32.36 / $128.82
| Facility | | $19.05 | $32.36 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $14.13 / $46.77
| Professional | | $11.48 | $14.13 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $28.18 / $39.81
| Professional | | $11.48 | $28.18 | $39.81 |