- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.11 / $22.62 / $420.42
| Facility | | $19.11 | $22.62 | $420.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.04 / $22.62 / $44.84
| Professional | | $17.04 | $22.62 | $44.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.39 / $10.39 / $10.39
| Professional | | $10.39 | $10.39 | $10.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $55.65 / $65.67
| Professional | | $55.65 | $55.65 | $65.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.07 / $32.25 / $54.00
| Professional | | $10.07 | $32.25 | $54.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.93 / $19.89 / $36.78
| Professional | | $11.93 | $19.89 | $36.78 |