- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.77 / $15.30 / $20.81
| Professional | | $13.77 | $15.30 | $20.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.01 / $22.83 / $27.86
| Professional | | $11.01 | $22.83 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.80 / $33.28 / $38.70
| Professional | | $25.80 | $33.28 | $38.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.37 / $13.62 / $13.62
| Facility | | $11.37 | $13.62 | $13.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.77 / $13.17 / $19.70
| Professional | | $10.77 | $13.17 | $19.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.91 / $6.05 / $7.58
| Professional | | $5.91 | $6.05 | $7.58 |