- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.52 / $16.52 / $42.48
| Facility | | $16.52 | $16.52 | $42.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.34 / $17.05 / $22.18
| Professional | | $15.34 | $17.05 | $22.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.67 / $47.55 / $53.37
| Professional | | $35.67 | $47.55 | $53.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.26 / $27.53 / $34.61
| Professional | | $27.26 | $27.53 | $34.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.52 / $28.08 / $319.45
| Facility | | $16.52 | $28.08 | $319.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.91 / $23.00 / $40.11
| Professional | | $9.91 | $23.00 | $40.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.91 / $23.00 / $34.22
| Professional | | $9.91 | $23.00 | $34.22 |