- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.35 / $22.25 / $38.70
| Facility | | $19.35 | $22.25 | $38.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $22.25 / $22.25
| Professional | | $17.55 | $22.25 | $22.25 |
- 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
- $13.44 / $14.15 / $19.76
| Professional | | $13.44 | $14.15 | $19.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $20.38 / $60.59
| Facility | | $15.14 | $20.38 | $60.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.24 / $14.88 / $27.88
| Professional | | $10.24 | $14.88 | $27.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $11.36 / $27.05
| Professional | | $8.13 | $11.36 | $27.05 |