- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.66 / $87.10 / $177.83
| Facility | | $42.66 | $87.10 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $13.49 / $56.23
| Professional | | $11.22 | $13.49 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $28.84 / $33.88
| Professional | | $21.88 | $28.84 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $17.38 / $21.88
| Professional | | $17.38 | $17.38 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $66.07 / $173.78
| Facility | | $22.39 | $66.07 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $16.60 / $54.95
| Professional | | $7.59 | $16.60 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $16.60 / $25.70
| Professional | | $9.12 | $16.60 | $25.70 |