- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.39 / $4,221.67 / $6,442.32
| Facility | | $16.39 | $4,221.67 | $6,442.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $18.73 / $36.25
| Professional | | $15.61 | $18.73 | $36.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.30 / $14.30 / $15.73
| Facility | | $14.30 | $14.30 | $15.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.61 / $15.61 / $18.72
| Facility | | $15.61 | $15.61 | $18.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $15.61 / $15.61
| Professional | | $15.61 | $15.61 | $15.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.99 / $15.61 / $20.28
| Professional | | $14.99 | $15.61 | $20.28 |