- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.98 / $35.63 / $61.96
| Facility | | $30.98 | $35.63 | $61.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.87 / $35.63 / $35.63
| Professional | | $27.87 | $35.63 | $35.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.73 / $20.32 / $27.34
| Facility | | $16.73 | $20.32 | $27.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.52 / $22.65 / $31.62
| Professional | | $21.52 | $22.65 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.22 / $32.60 / $97.56
| Facility | | $24.22 | $32.60 | $97.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $23.82 / $44.40
| Professional | | $16.22 | $23.82 | $44.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.01 / $17.72 / $54.10
| Professional | | $13.01 | $17.72 | $54.10 |