- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.78 / $28.88 / $32.03
| Facility | | $15.78 | $28.88 | $32.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.47 / $17.36 / $30.30
| Professional | | $12.47 | $17.36 | $30.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.28 / $24.28 / $24.28
| Facility | | $24.28 | $24.28 | $24.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.28 / $24.28 / $24.28
| Professional | | $24.28 | $24.28 | $24.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.26 / $15.08 / $29.30
| Facility | | $10.26 | $15.08 | $29.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.05 / $9.51 / $22.72
| Professional | | $7.05 | $9.51 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.63 / $10.31 / $27.62
| Professional | | $6.63 | $10.31 | $27.62 |