- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.86 / $40.86 / $74.81
| Facility | | $40.86 | $40.86 | $74.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.31 / $24.68 / $64.61
| Professional | | $22.31 | $24.68 | $64.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.03 / $25.03 / $53.63
| Professional | | $25.03 | $25.03 | $53.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.45 / $57.45 / $57.45
| Facility | | $57.45 | $57.45 | $57.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.65 / $34.64 / $44.20
| Professional | | $11.65 | $34.64 | $44.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.70 / $27.38 / $43.81
| Professional | | $12.70 | $27.38 | $43.81 |