- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.05 / $38.52 / $42.73
| Facility | | $21.05 | $38.52 | $42.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.63 / $23.16 / $40.42
| Professional | | $16.63 | $23.16 | $40.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.04 / $33.04 / $33.04
| Facility | | $33.04 | $33.04 | $33.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.04 / $33.04 / $33.04
| Professional | | $33.04 | $33.04 | $33.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.68 / $19.60 / $38.10
| Facility | | $13.68 | $19.60 | $38.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.09 / $12.37 / $30.46
| Professional | | $9.09 | $12.37 | $30.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.84 / $12.63 / $35.93
| Professional | | $8.84 | $12.63 | $35.93 |