- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.62 / $22.62 / $31.03
| Facility | | $22.62 | $22.62 | $31.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.93 / $22.62 / $34.13
| Professional | | $15.93 | $22.62 | $34.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.52 / $26.03 / $35.78
| Professional | | $15.52 | $26.03 | $35.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $33.78 / $60.00
| Professional | | $5.00 | $33.78 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.81 / $24.23 / $32.15
| Professional | | $21.81 | $24.23 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.50 / $20.57 / $33.83
| Professional | | $16.50 | $20.57 | $33.83 |