- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.50 / $52.16 / $57.86
| Facility | | $28.50 | $52.16 | $57.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.52 / $31.35 / $54.72
| Professional | | $22.52 | $31.35 | $54.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.86 / $36.86 / $36.86
| Facility | | $36.86 | $36.86 | $36.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.86 / $36.86 / $36.86
| Professional | | $36.86 | $36.86 | $36.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.53 / $22.08 / $40.04
| Facility | | $18.53 | $22.08 | $40.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.79 / $13.01 / $40.78
| Professional | | $11.79 | $13.01 | $40.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $14.25 / $42.75
| Professional | | $11.39 | $14.25 | $42.75 |