- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.48 / $16.86 / $20.50
| Professional | | $14.48 | $16.86 | $20.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.55 / $19.55 / $19.55
| Facility | | $19.55 | $19.55 | $19.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $22.81 / $30.42
| Professional | | $16.98 | $22.81 | $30.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.54 / $32.34 / $32.34
| Professional | | $24.54 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.11 / $18.28 / $24.33
| Facility | | $15.11 | $18.28 | $24.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.30 / $25.59 / $45.39
| Professional | | $17.30 | $25.59 | $45.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.23 / $22.50 / $31.68
| Professional | | $16.23 | $22.50 | $31.68 |