- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.83 / $19.25 / $22.25
| Facility | | $16.83 | $19.25 | $22.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.17 / $17.67 / $23.85
| Professional | | $12.17 | $17.67 | $23.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.13 / $21.20 / $23.84
| Facility | | $21.13 | $21.20 | $23.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.35 / $12.35 / $25.84
| Professional | | $12.35 | $12.35 | $25.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.63 / $32.63 / $32.63
| Facility | | $32.63 | $32.63 | $32.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $14.22 / $14.22
| Professional | | $14.22 | $14.22 | $14.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.84 / $13.89 / $22.12
| Professional | | $9.84 | $13.89 | $22.12 |