- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.36 / $320.70 / $708.75
| Facility | | $36.36 | $320.70 | $708.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.69 / $34.86 / $37.13
| Professional | | $12.69 | $34.86 | $37.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.21 / $35.21 / $38.72
| Facility | | $35.21 | $35.21 | $38.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.53 / $33.53 / $33.53
| Professional | | $33.53 | $33.53 | $33.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.09 / $22.09 / $22.09
| Professional | | $22.09 | $22.09 | $22.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.25 / $15.00 / $19.50
| Professional | | $14.25 | $15.00 | $19.50 |