- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.50 / $32.78 / $57.00
| Facility | | $28.50 | $32.78 | $57.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.35 / $32.78 / $32.78
| Professional | | $31.35 | $32.78 | $32.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.73 / $20.32 / $27.34
| Facility | | $16.73 | $20.32 | $27.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.23 / $19.20 / $26.84
| Professional | | $18.23 | $19.20 | $26.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.57 / $27.69 / $89.34
| Facility | | $20.57 | $27.69 | $89.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.83 / $20.22 / $40.78
| Professional | | $13.83 | $20.22 | $40.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.97 / $15.44 / $36.75
| Professional | | $11.97 | $15.44 | $36.75 |