- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.05 / $33.61 / $40.34
| Facility | | $22.05 | $33.61 | $40.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.17 / $21.78 / $22.05
| Professional | | $20.17 | $21.78 | $22.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.58 / $36.29 / $40.34
| Facility | | $29.58 | $36.29 | $40.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.27 / $32.27 / $36.29
| Professional | | $32.27 | $32.27 | $36.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.85 / $50.00 / $80.67
| Facility | | $21.85 | $50.00 | $80.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.72 / $38.72 / $129.61
| Professional | | $9.72 | $38.72 | $129.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.09 / $10.54 / $33.89
| Professional | | $10.09 | $10.54 | $33.89 |