- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.83 / $34.25 / $45.67
| Facility | | $22.83 | $34.25 | $45.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.68 / $27.34 / $45.67
| Professional | | $23.68 | $27.34 | $45.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.23 / $23.97 / $31.28
| Professional | | $21.23 | $23.97 | $31.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.91 / $110.32 / $148.41
| Facility | | $90.91 | $110.32 | $148.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.70 / $31.00 / $36.58
| Professional | | $21.70 | $31.00 | $36.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.91 / $36.44 / $83.59
| Professional | | $25.91 | $36.44 | $83.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.61 / $25.24 / $37.19
| Professional | | $19.61 | $25.24 | $37.19 |