- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.06 / $44.03 / $48.84
| Facility | | $24.06 | $44.03 | $48.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.01 / $26.47 / $46.20
| Professional | | $19.01 | $26.47 | $46.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.25 / $32.25 / $32.25
| Facility | | $32.25 | $32.25 | $32.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.25 / $32.25 / $32.25
| Professional | | $32.25 | $32.25 | $32.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.64 / $19.55 / $35.17
| Facility | | $15.64 | $19.55 | $35.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $11.52 / $34.59
| Professional | | $10.46 | $11.52 | $34.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.11 / $12.88 / $36.09
| Professional | | $10.11 | $12.88 | $36.09 |