- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.78 / $33.78 / $35.77
| Facility | | $33.78 | $33.78 | $35.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.63 / $32.03 / $42.33
| Professional | | $26.63 | $32.03 | $42.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.51 / $53.26 / $61.33
| Facility | | $52.51 | $53.26 | $61.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.65 / $42.08 / $43.89
| Professional | | $34.65 | $42.08 | $43.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.11 / $35.11 / $37.36
| Facility | | $35.11 | $35.11 | $37.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.84 / $35.11 / $53.61
| Professional | | $29.84 | $35.11 | $53.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.37 / $28.55 / $46.48
| Professional | | $22.37 | $28.55 | $46.48 |