- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.82 / $33.82 / $61.91
| Facility | | $33.82 | $33.82 | $61.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.36 / $20.36 / $21.50
| Professional | | $20.36 | $20.36 | $21.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.37 / $25.37 / $47.85
| Professional | | $25.37 | $25.37 | $47.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $51.00
| Facility | | $51.00 | $51.00 | $51.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.43 / $39.63 / $71.14
| Professional | | $16.43 | $39.63 | $71.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.57 / $25.37 / $42.10
| Professional | | $13.57 | $25.37 | $42.10 |