- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.07 / $25.75 / $28.56
| Facility | | $14.07 | $25.75 | $28.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.12 / $15.48 / $27.01
| Professional | | $11.12 | $15.48 | $27.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.07 / $14.07 / $14.07
| Facility | | $14.07 | $14.07 | $14.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.07 / $14.07 / $14.07
| Professional | | $14.07 | $14.07 | $14.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.61 / $9.61 / $12.21
| Facility | | $5.61 | $9.61 | $12.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.54 / $6.41 / $20.13
| Professional | | $3.54 | $6.41 | $20.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.25 / $5.91 / $18.67
| Professional | | $4.25 | $5.91 | $18.67 |