- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.34 / $71.06 / $86.72
| Facility | | $50.34 | $71.06 | $86.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.82 / $19.80 / $26.93
| Professional | | $17.82 | $19.80 | $26.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.01 / $22.72 / $27.86
| Professional | | $11.01 | $22.72 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.80 / $33.28 / $38.70
| Professional | | $25.80 | $33.28 | $38.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.12 / $14.21 / $26.00
| Professional | | $11.12 | $14.21 | $26.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $4.61 / $5.73
| Professional | | $4.47 | $4.61 | $5.73 |