- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.52 / $22.55 / $22.55
| Facility | | $16.52 | $22.55 | $22.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.44 / $20.98 / $30.77
| Professional | | $17.44 | $20.98 | $30.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.65 / $26.22 / $41.95
| Professional | | $14.65 | $26.22 | $41.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.06 / $27.73 / $77.89
| Professional | | $21.06 | $27.73 | $77.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.29 / $25.18 / $55.00
| Facility | | $22.29 | $25.18 | $55.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.50 / $22.50 / $22.50
| Professional | | $22.50 | $22.50 | $22.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $17.04 / $54.53
| Professional | | $10.84 | $17.04 | $54.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $16.82 / $35.40
| Professional | | $10.00 | $16.82 | $35.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.42 / $183.42 / $183.42
| Facility | | $183.42 | $183.42 | $183.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.52 / $307.52 / $307.52
| Professional | | $307.52 | $307.52 | $307.52 |