- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.38 / $16.38 / $30.30
| Facility | | $16.38 | $16.38 | $30.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $16.38 / $20.52
| Professional | | $13.36 | $16.38 | $20.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.62 / $20.18 / $35.15
| Professional | | $14.62 | $20.18 | $35.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $22.52 / $32.47
| Professional | | $16.89 | $22.52 | $32.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.70 / $18.23 / $30.49
| Professional | | $12.70 | $18.23 | $30.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.82 / $16.47 / $29.63
| Professional | | $11.82 | $16.47 | $29.63 |