- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.36 / $31.36 / $32.35
| Facility | | $31.36 | $31.36 | $32.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.02 / $31.36 / $32.35
| Professional | | $13.02 | $31.36 | $32.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.68 / $30.68 / $33.75
| Facility | | $30.68 | $30.68 | $33.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.22 / $29.22 / $29.22
| Professional | | $29.22 | $29.22 | $29.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $26.66 / $26.66
| Facility | | $22.39 | $26.66 | $26.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.51 / $22.66 / $31.36
| Professional | | $22.51 | $22.66 | $31.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.54 / $17.89 / $39.63
| Professional | | $12.54 | $17.89 | $39.63 |