- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.27 / $26.27 / $133.19
| Facility | | $26.27 | $26.27 | $133.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.71 / $26.65 / $32.40
| Professional | | $23.71 | $26.65 | $32.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.41 / $26.37 / $30.66
| Facility | | $22.41 | $26.37 | $30.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.89 / $38.14 / $63.08
| Professional | | $21.89 | $38.14 | $63.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.54 / $43.67 / $72.34
| Professional | | $36.54 | $43.67 | $72.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.44 / $10.18 / $45.48
| Professional | | $8.44 | $10.18 | $45.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.47 / $51.66 / $87.74
| Professional | | $20.47 | $51.66 | $87.74 |