- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $80.06 / $80.06
| Facility | | $10.72 | $80.06 | $80.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $13.89 / $27.58
| Professional | | $13.36 | $13.89 | $27.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $30.87 / $34.64
| Professional | | $25.47 | $30.87 | $34.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $17.52 / $22.03
| Professional | | $17.35 | $17.52 | $22.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $23.60 / $206.91
| Facility | | $10.72 | $23.60 | $206.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $18.38 / $26.04
| Professional | | $7.60 | $18.38 | $26.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.43 / $16.85 / $22.21
| Professional | | $6.43 | $16.85 | $22.21 |