- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.52 / $23.66 / $28.40
| Facility | | $15.52 | $23.66 | $28.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.20 / $15.33 / $15.52
| Professional | | $14.20 | $15.33 | $15.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.82 / $25.56 / $28.40
| Facility | | $20.82 | $25.56 | $28.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.72 / $22.72 / $25.56
| Professional | | $22.72 | $22.72 | $25.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.38 / $35.82 / $56.76
| Facility | | $15.38 | $35.82 | $56.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.85 / $27.36 / $123.03
| Professional | | $10.85 | $27.36 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $11.36 / $26.46
| Professional | | $8.52 | $11.36 | $26.46 |