- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.68 / $72.76 / $72.76
| Facility | | $17.68 | $72.76 | $72.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.41 / $22.45 / $76.54
| Professional | | $16.41 | $22.45 | $76.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.15 / $50.88 / $57.09
| Professional | | $38.15 | $50.88 | $57.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.91 / $29.20 / $36.72
| Professional | | $28.91 | $29.20 | $36.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.68 / $37.88 / $120.30
| Facility | | $17.68 | $37.88 | $120.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.52 / $30.30 / $43.30
| Professional | | $12.52 | $30.30 | $43.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $17.67 / $43.30
| Professional | | $10.61 | $17.67 | $43.30 |