- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.38 / $34.11 / $40.94
| Facility | | $22.38 | $34.11 | $40.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.47 / $22.38 / $23.20
| Professional | | $20.47 | $22.38 | $23.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.02 / $40.94 / $47.76
| Facility | | $30.02 | $40.94 | $47.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.75 / $32.75 / $36.84
| Professional | | $32.75 | $32.75 | $36.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.18 / $50.00 / $81.87
| Facility | | $22.18 | $50.00 | $81.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.41 / $37.46 / $131.54
| Professional | | $11.41 | $37.46 | $131.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.77 / $13.65 / $40.63
| Professional | | $11.77 | $13.65 | $40.63 |