- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.23 / $47.64 / $365.24
| Facility | | $23.23 | $47.64 | $365.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.53 / $26.10 / $26.10
| Professional | | $18.53 | $26.10 | $26.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.52 / $14.52 / $14.52
| Facility | | $14.52 | $14.52 | $14.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.61 / $25.89 / $67.54
| Professional | | $25.61 | $25.89 | $67.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.34 / $59.42 / $93.02
| Facility | | $22.34 | $59.42 | $93.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.38 / $13.40 / $33.51
| Professional | | $9.38 | $13.40 | $33.51 |