- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.76 / $43.49 / $92.57
| Facility | | $23.76 | $43.49 | $92.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.73 / $26.32 / $26.77
| Professional | | $25.73 | $26.32 | $26.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.75 / $34.78 / $37.79
| Facility | | $19.75 | $34.78 | $37.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.51 / $22.15 / $56.22
| Professional | | $15.51 | $22.15 | $56.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.76 / $70.48 / $123.91
| Facility | | $27.76 | $70.48 | $123.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.30 / $32.65 / $42.33
| Professional | | $21.30 | $32.65 | $42.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.34 / $17.72 / $38.84
| Professional | | $10.34 | $17.72 | $38.84 |