- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.73 / $21.02 / $21.02
| Facility | | $19.73 | $21.02 | $21.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.44 / $15.17 / $15.17
| Professional | | $14.44 | $15.17 | $15.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.88 / $11.88 / $11.88
| Facility | | $11.88 | $11.88 | $11.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.14 / $21.06 / $34.36
| Professional | | $13.14 | $21.06 | $34.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.68 / $10.97 / $27.42
| Professional | | $7.68 | $10.97 | $27.42 |