- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.60 / $39.60 / $67.98
| Facility | | $39.60 | $39.60 | $67.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.22 / $19.13 / $26.02
| Professional | | $17.22 | $19.13 | $26.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.01 / $20.65 / $27.86
| Professional | | $11.01 | $20.65 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.80 / $33.28 / $38.70
| Professional | | $25.80 | $33.28 | $38.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.77 / $14.02 / $26.00
| Professional | | $10.77 | $14.02 | $26.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.95 / $6.05 / $7.63
| Professional | | $5.95 | $6.05 | $7.63 |