- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.28 / $33.67 / $58.56
| Facility | | $29.28 | $33.67 | $58.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.92 / $26.15 / $27.52
| Professional | | $23.92 | $26.15 | $27.52 |
- 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
- $19.67 / $20.71 / $29.88
| Professional | | $19.67 | $20.71 | $29.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.72 / $23.79 / $91.39
| Facility | | $20.72 | $23.79 | $91.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.44 / $20.46 / $42.33
| Professional | | $13.44 | $20.46 | $42.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $13.66 / $32.53
| Professional | | $12.30 | $13.66 | $32.53 |