- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.58 / $48.64 / $53.96
| Facility | | $26.58 | $48.64 | $53.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.00 / $29.24 / $51.03
| Professional | | $21.00 | $29.24 | $51.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.86 / $40.86 / $40.86
| Facility | | $40.86 | $40.86 | $40.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.86 / $40.86 / $40.86
| Professional | | $40.86 | $40.86 | $40.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.28 / $27.52 / $53.24
| Facility | | $17.28 | $27.52 | $53.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.08 / $17.36 / $38.20
| Professional | | $12.08 | $17.36 | $38.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.31 / $12.35 / $47.10
| Professional | | $10.31 | $12.35 | $47.10 |