- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.64 / $21.33 / $78.56
| Professional | | $11.64 | $21.33 | $78.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.71 / $208.10 / $216.68
| Facility | | $94.71 | $208.10 | $216.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.45 / $20.45 / $20.45
| Facility | | $20.45 | $20.45 | $20.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.40 / $21.82 / $30.81
| Professional | | $8.40 | $21.82 | $30.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.45 / $20.45 / $20.45
| Facility | | $20.45 | $20.45 | $20.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.40 / $19.98 / $25.41
| Professional | | $8.40 | $19.98 | $25.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.34 / $17.11 / $28.23
| Professional | | $5.34 | $17.11 | $28.23 |