- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.55 / $12.55 / $32.27
| Facility | | $12.55 | $12.55 | $32.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.45 / $15.98 / $46.50
| Professional | | $13.45 | $15.98 | $46.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.01 / $31.77 / $39.74
| Professional | | $27.01 | $31.77 | $39.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.65 / $20.86 / $26.23
| Professional | | $20.65 | $20.86 | $26.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.55 / $26.90 / $188.30
| Facility | | $12.55 | $26.90 | $188.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.75 / $21.52 / $30.48
| Professional | | $7.75 | $21.52 | $30.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.53 / $18.82 / $30.48
| Professional | | $7.53 | $18.82 | $30.48 |