- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.94 / $38.32 / $42.51
| Facility | | $20.94 | $38.32 | $42.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.54 / $23.03 / $40.20
| Professional | | $16.54 | $23.03 | $40.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.47 / $35.47 / $35.47
| Facility | | $35.47 | $35.47 | $35.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.47 / $35.47 / $35.47
| Professional | | $35.47 | $35.47 | $35.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.61 / $19.48 / $37.61
| Facility | | $13.61 | $19.48 | $37.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.09 / $12.30 / $30.46
| Professional | | $9.09 | $12.30 | $30.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.78 / $12.56 / $35.74
| Professional | | $8.78 | $12.56 | $35.74 |