- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.20 / $20.62 / $38.90
| Facility | | $20.20 | $20.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $18.34 / $25.66
| Professional | | $10.19 | $18.34 | $25.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.49 / $18.45 / $33.02
| Professional | | $12.49 | $18.45 | $33.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.24 / $23.05 / $40.20
| Professional | | $13.24 | $23.05 | $40.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.81 / $20.82 / $41.40
| Facility | | $10.81 | $20.82 | $41.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.02 / $31.79 / $250.96
| Professional | | $20.02 | $31.79 | $250.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.47 / $25.82 / $39.74
| Professional | | $19.47 | $25.82 | $39.74 |