- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.40 / $9.42 / $14.73
| Professional | | $7.40 | $9.42 | $14.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.42 / $13.42 / $14.88
| Professional | | $13.42 | $13.42 | $14.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $11.06 / $12.29
| Professional | | $8.36 | $11.06 | $12.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.65 / $10.65 / $10.65
| Facility | | $10.65 | $10.65 | $10.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $10.23 / $15.44
| Professional | | $7.83 | $10.23 | $15.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.10 / $15.43 / $17.11
| Professional | | $13.10 | $15.43 | $17.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.22 / $8.77 / $13.98
| Professional | | $7.22 | $8.77 | $13.98 |