- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.69 / $22.26 / $32.61
| Facility | | $12.69 | $22.26 | $32.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.70 / $17.68 / $30.85
| Professional | | $12.70 | $17.68 | $30.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.03 / $21.03 / $21.03
| Facility | | $21.03 | $21.03 | $21.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.03 / $21.03 / $21.03
| Professional | | $21.03 | $21.03 | $21.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.45 / $13.29 / $23.93
| Facility | | $10.45 | $13.29 | $23.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.05 / $7.83 / $23.23
| Professional | | $7.05 | $7.83 | $23.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $8.76 / $27.43
| Professional | | $6.75 | $8.76 | $27.43 |