- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.48 / $14.48 / $18.16
| Professional | | $14.48 | $14.48 | $18.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.55 / $23.61 / $35.79
| Facility | | $17.55 | $23.61 | $35.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.34 / $17.04 / $17.55
| Professional | | $8.34 | $17.04 | $17.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.07 / $20.59 / $35.79
| Facility | | $16.07 | $20.59 | $35.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.90 / $12.11 / $17.55
| Professional | | $10.90 | $12.11 | $17.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $5.09 / $16.64
| Professional | | $5.09 | $5.09 | $16.64 |