- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.45 / $65.18 / $159.93
| Facility | | $63.45 | $65.18 | $159.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.82 / $21.78 / $25.47
| Professional | | $17.82 | $21.78 | $25.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.34 / $51.32 / $57.60
| Professional | | $42.34 | $51.32 | $57.60 |
- 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
- $18.07 / $49.28 / $121.47
| Facility | | $18.07 | $49.28 | $121.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.74 / $30.56 / $79.20
| Professional | | $12.74 | $30.56 | $79.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $17.82 / $43.68
| Professional | | $10.70 | $17.82 | $43.68 |