- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.03 / $34.53 / $60.06
| Facility | | $30.03 | $34.53 | $60.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.42 / $29.13 / $34.53
| Professional | | $23.42 | $29.13 | $34.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.58 / $44.39 / $59.72
| Facility | | $36.58 | $44.39 | $59.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.70 / $20.13 / $23.75
| Professional | | $13.70 | $20.13 | $23.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.52 / $24.40 / $94.48
| Facility | | $19.52 | $24.40 | $94.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.04 / $14.17 / $111.44
| Professional | | $12.04 | $14.17 | $111.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.61 / $12.61 / $18.02
| Professional | | $12.61 | $12.61 | $18.02 |