- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.65 / $35.52 / $37.29
| Facility | | $28.65 | $35.52 | $37.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $25.07 / $35.52
| Professional | | $23.88 | $25.07 | $35.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.11 / $32.11 / $32.11
| Facility | | $32.11 | $32.11 | $32.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.74 / $32.11 / $32.11
| Professional | | $28.74 | $32.11 | $32.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.53 / $23.88 / $60.82
| Facility | | $22.53 | $23.88 | $60.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $23.88 / $29.93
| Professional | | $23.88 | $23.88 | $29.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $24.60 / $30.57
| Professional | | $23.88 | $24.60 | $30.57 |