- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.13 / $26.60 / $46.26
| Facility | | $23.13 | $26.60 | $46.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.44 / $26.60 / $26.60
| Professional | | $25.44 | $26.60 | $26.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.88 / $16.84 / $22.66
| Facility | | $13.88 | $16.84 | $22.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.01 / $15.01 / $22.83
| Professional | | $15.01 | $15.01 | $22.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.48 / $23.56 / $72.91
| Facility | | $17.48 | $23.56 | $72.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.20 / $22.51 / $59.01
| Professional | | $17.20 | $22.51 | $59.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.71 / $13.12 / $31.24
| Professional | | $9.71 | $13.12 | $31.24 |