- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.82 / $18.82 / $153.61
| Facility | | $18.82 | $18.82 | $153.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.71 / $18.82 / $18.82
| Professional | | $16.71 | $18.82 | $18.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.07 / $22.59 / $23.27
| Professional | | $20.07 | $22.59 | $23.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.79 / $42.43 / $91.66
| Facility | | $40.79 | $42.43 | $91.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.10 / $51.02 / $51.02
| Professional | | $25.10 | $51.02 | $51.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $11.70 / $22.84
| Professional | | $10.54 | $11.70 | $22.84 |