- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.48 / $46.63 / $51.72
| Facility | | $25.48 | $46.63 | $51.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.13 / $28.03 / $48.92
| Professional | | $20.13 | $28.03 | $48.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.02 / $107.02 / $107.02
| Professional | | $107.02 | $107.02 | $107.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.51 / $43.51 / $43.51
| Facility | | $43.51 | $43.51 | $43.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.51 / $43.51 / $43.51
| Professional | | $43.51 | $43.51 | $43.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.55 / $26.38 / $50.79
| Facility | | $16.55 | $26.38 | $50.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.63 / $16.64 / $36.65
| Professional | | $11.63 | $16.64 | $36.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $16.55 / $39.15
| Professional | | $10.70 | $16.55 | $39.15 |