- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.19 / $71.04 / $130.84
| Facility | | $65.19 | $71.04 | $130.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.51 / $14.51 / $14.51
| Professional | | $14.51 | $14.51 | $14.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.48 / $84.67 / $193.58
| Professional | | $15.48 | $84.67 | $193.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.45 / $32.71 / $70.23
| Facility | | $31.45 | $32.71 | $70.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.52 / $22.30 / $27.88
| Professional | | $10.52 | $22.30 | $27.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.33 / $39.33 / $39.33
| Professional | | $39.33 | $39.33 | $39.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $15.67 / $33.00
| Professional | | $11.36 | $15.67 | $33.00 |