- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.30 / $21.30 / $22.55
| Facility | | $21.30 | $21.30 | $22.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $18.55 / $26.47
| Professional | | $12.02 | $18.55 | $26.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.38 / $35.20 / $43.07
| Facility | | $33.38 | $35.20 | $43.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.20 / $26.71 / $26.78
| Professional | | $21.20 | $26.71 | $26.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.28 / $22.28 / $29.25
| Facility | | $22.28 | $22.28 | $29.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.94 / $22.28 / $33.52
| Professional | | $18.94 | $22.28 | $33.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.51 / $17.96 / $28.14
| Professional | | $12.51 | $17.96 | $28.14 |