- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.87 / $25.38 / $28.16
| Facility | | $13.87 | $25.38 | $28.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $15.26 / $26.63
| Professional | | $10.96 | $15.26 | $26.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.68 / $23.68 / $23.68
| Facility | | $23.68 | $23.68 | $23.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.68 / $23.68 / $23.68
| Professional | | $23.68 | $23.68 | $23.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.02 / $14.36 / $27.84
| Facility | | $9.02 | $14.36 | $27.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.26 / $9.06 / $20.13
| Professional | | $6.26 | $9.06 | $20.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.83 / $8.32 / $26.30
| Professional | | $5.83 | $8.32 | $26.30 |