- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.12 / $26.70 / $27.03
| Professional | | $19.12 | $26.70 | $27.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.62 / $16.62 / $20.38
| Facility | | $16.62 | $16.62 | $20.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.13 / $16.62 / $17.73
| Professional | | $12.13 | $16.62 | $17.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.01 / $23.01 / $31.76
| Facility | | $8.01 | $23.01 | $31.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.58 / $30.17 / $31.76
| Professional | | $28.58 | $30.17 | $31.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.89 / $23.73 / $30.00
| Professional | | $22.89 | $23.73 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.81 / $31.02 / $46.53
| Facility | | $27.81 | $31.02 | $46.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.23 / $22.23 / $33.35
| Professional | | $22.23 | $22.23 | $33.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.25 / $16.25 / $16.25
| Facility | | $16.25 | $16.25 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.47 / $12.40 / $39.76
| Professional | | $11.47 | $12.40 | $39.76 |