- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $60.26 / $138.04
| Facility | | $19.05 | $60.26 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $18.20 / $61.66
| Professional | | $14.13 | $18.20 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $40.74 / $45.71
| Professional | | $30.20 | $40.74 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $30.20
| Professional | | $23.44 | $23.44 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $30.20 / $97.72
| Facility | | $14.13 | $30.20 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $14.13 / $34.67
| Professional | | $10.00 | $14.13 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $20.89 / $34.67
| Professional | | $10.00 | $20.89 | $34.67 |