- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $27.09
| Facility | | $10.54 | $10.54 | $27.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.94 / $25.88 / $39.11
| Professional | | $12.94 | $25.88 | $39.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.66 / $30.33 / $33.86
| Professional | | $22.66 | $30.33 | $33.86 |
- 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
- $10.54 / $22.58 / $146.16
| Facility | | $10.54 | $22.58 | $146.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.47 / $18.05 / $25.81
| Professional | | $7.47 | $18.05 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.32 / $15.35 / $25.81
| Professional | | $6.32 | $15.35 | $25.81 |