- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.37 / $20.37 / $21.57
| Facility | | $20.37 | $20.37 | $21.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.35 / $18.84 / $24.70
| Professional | | $15.35 | $18.84 | $24.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.32 / $32.45 / $41.55
| Facility | | $31.32 | $32.45 | $41.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.74 / $25.32 / $25.53
| Professional | | $20.74 | $25.32 | $25.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $27.20
| Facility | | $20.72 | $20.72 | $27.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.61 / $20.72 / $33.04
| Professional | | $17.61 | $20.72 | $33.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.66 / $16.57 / $25.55
| Professional | | $11.66 | $16.57 | $25.55 |