- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.89 / $119.94 / $157.25
| Facility | | $22.89 | $119.94 | $157.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.89 / $22.89 / $24.25
| Professional | | $22.89 | $22.89 | $24.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.97 / $25.68 / $80.50
| Facility | | $24.97 | $25.68 | $80.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.47 / $30.11 / $53.32
| Professional | | $13.47 | $30.11 | $53.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.22 / $33.60 / $118.34
| Facility | | $29.22 | $33.60 | $118.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.62 / $31.60 / $35.11
| Professional | | $25.62 | $31.60 | $35.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.27 / $12.36 / $29.22
| Professional | | $12.27 | $12.36 | $29.22 |