- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.52 / $159.41 / $376.31
| Facility | | $19.52 | $159.41 | $376.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.59 / $19.72 / $43.34
| Professional | | $18.59 | $19.72 | $43.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.84 / $27.84 / $30.62
| Facility | | $27.84 | $27.84 | $30.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.59 / $18.59 / $18.59
| Facility | | $18.59 | $18.59 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.59 / $18.59 / $18.59
| Professional | | $18.59 | $18.59 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.85 / $18.59 / $24.17
| Professional | | $17.85 | $18.59 | $24.17 |