- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.61 / $83.49 / $173.48
| Facility | | $45.61 | $83.49 | $173.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.74 / $24.74 / $29.02
| Professional | | $24.74 | $24.74 | $29.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.53 / $37.11 / $56.50
| Facility | | $35.53 | $37.11 | $56.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.84 / $22.63 / $53.03
| Professional | | $15.84 | $22.63 | $53.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.69 / $34.69 / $43.37
| Professional | | $34.69 | $34.69 | $43.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.67 / $39.68 / $55.11
| Professional | | $12.67 | $39.68 | $55.11 |