- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.08 / $37.40 / $971.72
| Facility | | $31.08 | $37.40 | $971.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.08 / $32.64 / $45.88
| Professional | | $31.08 | $32.64 | $45.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.59 / $13.59 / $13.59
| Facility | | $13.59 | $13.59 | $13.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.86 / $19.98 / $19.98
| Facility | | $13.86 | $19.98 | $19.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.98 / $19.98 / $19.98
| Professional | | $19.98 | $19.98 | $19.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.49 / $40.09 / $61.74
| Professional | | $38.49 | $40.09 | $61.74 |