- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.06 / $43.25 / $116.78
| Facility | | $22.06 | $43.25 | $116.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $22.79 / $26.69
| Professional | | $20.72 | $22.79 | $26.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.54 / $20.72 / $20.72
| Facility | | $19.54 | $20.72 | $20.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $20.72
| Professional | | $20.72 | $20.72 | $20.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.11 / $25.90 / $37.04
| Facility | | $4.11 | $25.90 | $37.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.80 / $22.79 / $25.90
| Professional | | $5.80 | $22.79 | $25.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.86 / $24.86 / $25.90
| Professional | | $24.86 | $24.86 | $25.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $29.01
| Professional | | $20.72 | $20.72 | $29.01 |