- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $34.67 / $77.62
| Facility | | $10.96 | $34.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $30.20 / $57.54
| Professional | | $10.00 | $30.20 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $42.66 / $60.26
| Professional | | $31.62 | $42.66 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $26.92 / $26.92
| Professional | | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $61.66 / $61.66
| Professional | | $50.12 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $35.48 / $35.48
| Professional | | $30.20 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $27.54 / $45.71
| Professional | | $14.45 | $27.54 | $45.71 |