- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.82 / $21.06 / $25.28
| Facility | | $13.82 | $21.06 | $25.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.64 / $13.65 / $13.82
| Professional | | $12.64 | $13.65 | $13.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.54 / $22.75 / $25.28
| Facility | | $18.54 | $22.75 | $25.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.22 / $20.22 / $22.75
| Professional | | $20.22 | $20.22 | $22.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.69 / $35.78 / $50.53
| Facility | | $13.69 | $35.78 | $50.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.17 / $24.26 / $81.22
| Professional | | $8.17 | $24.26 | $81.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $8.74 / $26.96
| Professional | | $7.08 | $8.74 | $26.96 |