- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.11 / $49.61 / $55.03
| Facility | | $27.11 | $49.61 | $55.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.42 / $29.82 / $52.05
| Professional | | $21.42 | $29.82 | $52.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.65 / $33.65 / $33.65
| Facility | | $33.65 | $33.65 | $33.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.65 / $33.65 / $33.65
| Professional | | $33.65 | $33.65 | $33.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.59 / $20.01 / $36.74
| Facility | | $17.59 | $20.01 | $36.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.17 / $12.38 / $39.24
| Professional | | $10.17 | $12.38 | $39.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $13.56 / $46.28
| Professional | | $11.39 | $13.56 | $46.28 |