- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.72 / $32.71 / $32.71
| Professional | | $14.72 | $32.71 | $32.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $23.43
| Facility | | $21.38 | $21.38 | $23.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $21.38 / $22.78
| Professional | | $15.61 | $21.38 | $22.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.02 / $26.31 / $37.36
| Facility | | $11.02 | $26.31 | $37.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.61 / $35.49 / $37.36
| Professional | | $33.61 | $35.49 | $37.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.91 / $30.00 / $33.61
| Professional | | $27.91 | $30.00 | $33.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.71 / $36.47 / $54.72
| Facility | | $32.71 | $36.47 | $54.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.15 / $27.11 / $39.22
| Professional | | $26.15 | $27.11 | $39.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $17.05 / $26.29
| Professional | | $15.77 | $17.05 | $26.29 |