- 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
- $23.43 / $25.64 / $25.64
| Facility | | $23.43 | $25.64 | $25.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.72 / $25.64 / $27.34
| Professional | | $18.72 | $25.64 | $27.34 |
- 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 / $24.96
| Professional | | $15.77 | $17.05 | $24.96 |