- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $30.60 / $41.62
| Professional | | $27.54 | $30.60 | $41.62 |
- 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 / $11.37 / $13.62
| Facility | | $11.37 | $11.37 | $13.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.52 / $12.55 / $23.14
| Professional | | $10.52 | $12.55 | $23.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.73 / $7.92 / $9.91
| Professional | | $7.73 | $7.92 | $9.91 |