- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.32 / $28.19 / $87.40
| Facility | | $20.32 | $28.19 | $87.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.36 / $20.34 / $20.34
| Professional | | $19.36 | $20.34 | $20.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.93 / $15.93 / $15.93
| Facility | | $15.93 | $15.93 | $15.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.57 / $28.08 / $45.65
| Professional | | $17.57 | $28.08 | $45.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.29 / $12.15 / $34.22
| Professional | | $10.29 | $12.15 | $34.22 |