- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.87 / $52.86 / $135.80
| Facility | | $26.87 | $52.86 | $135.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $25.85 / $91.46
| Professional | | $17.02 | $25.85 | $91.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.61 / $31.99 / $49.15
| Professional | | $24.61 | $31.99 | $49.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.69 / $38.15 / $141.93
| Professional | | $15.69 | $38.15 | $141.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.54 / $43.85 / $57.15
| Professional | | $33.54 | $43.85 | $57.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.27 / $24.80 / $33.61
| Professional | | $18.27 | $24.80 | $33.61 |