- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.10 / $21.56 / $121.38
| Facility | | $16.10 | $21.56 | $121.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.25 / $21.83 / $25.11
| Professional | | $18.25 | $21.83 | $25.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.76 / $24.56 / $28.68
| Facility | | $16.76 | $24.56 | $28.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.92 / $16.39 / $27.30
| Professional | | $10.92 | $16.39 | $27.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.75 / $38.21 / $45.03
| Facility | | $32.75 | $38.21 | $45.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.38 / $36.84 / $54.58
| Professional | | $31.38 | $36.84 | $54.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.73 / $21.23 / $50.00
| Facility | | $17.73 | $21.23 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.42 / $33.61 / $131.54
| Professional | | $12.42 | $33.61 | $131.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.17 / $16.53 / $30.02
| Professional | | $13.17 | $16.53 | $30.02 |