- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.10 / $29.46 / $32.68
| Facility | | $16.10 | $29.46 | $32.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.72 / $17.71 / $30.91
| Professional | | $12.72 | $17.71 | $30.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.04 / $21.04 / $21.04
| Facility | | $21.04 | $21.04 | $21.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.04 / $21.04 / $21.04
| Professional | | $21.04 | $21.04 | $21.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $13.29 / $23.93
| Facility | | $10.47 | $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
- $6.76 / $8.76 / $27.48
| Professional | | $6.76 | $8.76 | $27.48 |