- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.51 / $23.64 / $28.37
| Facility | | $15.51 | $23.64 | $28.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.18 / $15.32 / $15.51
| Professional | | $14.18 | $15.32 | $15.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.80 / $25.53 / $28.37
| Facility | | $20.80 | $25.53 | $28.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.69 / $22.69 / $25.53
| Professional | | $22.69 | $22.69 | $25.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.36 / $34.32 / $56.72
| Facility | | $15.36 | $34.32 | $56.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $26.85 / $91.15
| Professional | | $10.70 | $26.85 | $91.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $11.10 / $30.73
| Professional | | $7.94 | $11.10 | $30.73 |