- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.13 / $23.13 / $25.70
| Facility | | $23.13 | $23.13 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.13 / $23.57 / $31.16
| Professional | | $18.13 | $23.57 | $31.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.45 / $30.45 / $57.63
| Professional | | $22.45 | $30.45 | $57.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.26 / $40.26 / $40.26
| Facility | | $40.26 | $40.26 | $40.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.16 / $29.16 / $45.72
| Professional | | $29.16 | $29.16 | $45.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.18 / $24.54 / $35.15
| Facility | | $17.18 | $24.54 | $35.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.55 / $25.65 / $45.00
| Professional | | $22.55 | $25.65 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.23 / $32.22 / $64.09
| Professional | | $24.23 | $32.22 | $64.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.53 / $151.53 / $151.53
| Facility | | $151.53 | $151.53 | $151.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.37 / $244.65 / $267.30
| Professional | | $175.37 | $244.65 | $267.30 |