- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.38 / $23.44 / $35.48
| Facility | | $17.38 | $23.44 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $28.84 / $33.88
| Professional | | $20.42 | $28.84 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $16.98
| Facility | | $16.22 | $16.22 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $25.12 / $33.88
| Professional | | $18.62 | $25.12 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $19.05 / $34.67
| Professional | | $15.49 | $19.05 | $34.67 |