- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.36 / $31.53 / $54.56
| Facility | | $22.36 | $31.53 | $54.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.14 / $21.84 / $22.36
| Professional | | $18.14 | $21.84 | $22.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.89 / $21.05 / $23.16
| Facility | | $17.89 | $21.05 | $23.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $21.05
| Professional | | $21.05 | $21.05 | $21.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.68 / $23.68 / $23.68
| Professional | | $23.68 | $23.68 | $23.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $26.31
| Professional | | $21.05 | $21.05 | $26.31 |