- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.84 / $82.47 / $135.86
| Facility | | $52.84 | $82.47 | $135.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.07 / $21.47 / $38.61
| Professional | | $17.07 | $21.47 | $38.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.30 / $80.66 / $106.97
| Facility | | $51.30 | $80.66 | $106.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.91 / $20.85 / $33.29
| Professional | | $16.91 | $20.85 | $33.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.87 / $35.13 / $90.00
| Facility | | $25.87 | $35.13 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.00 / $125.69 / $125.69
| Professional | | $32.00 | $125.69 | $125.69 |