- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.62 / $37.54 / $45.05
| Facility | | $24.62 | $37.54 | $45.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.52 / $24.62 / $25.53
| Professional | | $22.52 | $24.62 | $25.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.03 / $45.05 / $52.55
| Facility | | $33.03 | $45.05 | $52.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.04 / $36.04 / $40.54
| Professional | | $36.04 | $36.04 | $40.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.40 / $50.00 / $90.08
| Facility | | $24.40 | $50.00 | $90.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.41 / $37.46 / $144.74
| Professional | | $11.41 | $37.46 | $144.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.77 / $14.01 / $40.63
| Professional | | $11.77 | $14.01 | $40.63 |