- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.47 / $51.46 / $53.38
| Facility | | $38.47 | $51.46 | $53.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.42 / $12.60 / $13.59
| Professional | | $12.42 | $12.60 | $13.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.85 / $29.14 / $32.70
| Professional | | $21.85 | $29.14 | $32.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $17.10 / $21.50
| Professional | | $16.93 | $17.10 | $21.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.11 / $22.33 / $70.28
| Facility | | $10.11 | $22.33 | $70.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.17 / $17.35 / $24.80
| Professional | | $7.17 | $17.35 | $24.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.07 / $14.75 / $24.80
| Professional | | $6.07 | $14.75 | $24.80 |