- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.87 / $123.52 / $124.50
| Facility | | $17.87 | $123.52 | $124.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.88 / $22.24 / $23.15
| Professional | | $18.88 | $22.24 | $23.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.44 / $51.44 / $57.73
| Professional | | $42.44 | $51.44 | $57.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.32 / $29.62 / $37.24
| Professional | | $29.32 | $29.62 | $37.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.87 / $38.29 / $169.40
| Facility | | $17.87 | $38.29 | $169.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.66 / $30.64 / $43.78
| Professional | | $12.66 | $30.64 | $43.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $17.86 / $43.78
| Professional | | $10.72 | $17.86 | $43.78 |