- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.53 / $17.10 / $25.77
| Facility | | $16.53 | $17.10 | $25.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.70 / $18.60 / $18.60
| Professional | | $17.70 | $18.60 | $18.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.57 / $14.57 / $14.57
| Facility | | $14.57 | $14.57 | $14.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.85 / $25.61 / $36.32
| Professional | | $13.85 | $25.61 | $36.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.41 / $12.98 / $27.04
| Professional | | $9.41 | $12.98 | $27.04 |