- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.23 / $33.89 / $40.67
| Facility | | $22.23 | $33.89 | $40.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.32 / $21.96 / $22.23
| Professional | | $20.32 | $21.96 | $22.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.82 / $36.60 / $40.67
| Facility | | $29.82 | $36.60 | $40.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.53 / $32.53 / $36.60
| Professional | | $32.53 | $32.53 | $36.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.03 / $32.53 / $81.31
| Facility | | $22.03 | $32.53 | $81.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.72 / $39.24 / $130.66
| Professional | | $9.72 | $39.24 | $130.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.34 / $12.20 / $33.25
| Professional | | $10.34 | $12.20 | $33.25 |