- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.47 / $28.15 / $33.78
| Facility | | $18.47 | $28.15 | $33.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $18.23 / $18.47
| Professional | | $16.89 | $18.23 | $18.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.77 / $30.40 / $33.78
| Facility | | $24.77 | $30.40 | $33.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.02 / $27.02 / $30.40
| Professional | | $27.02 | $27.02 | $30.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.30 / $40.83 / $67.56
| Facility | | $18.30 | $40.83 | $67.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.82 / $32.52 / $143.22
| Professional | | $12.82 | $32.52 | $143.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.13 / $13.80 / $36.03
| Professional | | $10.13 | $13.80 | $36.03 |