- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.22 / $17.22 / $18.39
| Facility | | $17.22 | $17.22 | $18.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.35 / $15.42 / $20.30
| Professional | | $11.35 | $15.42 | $20.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.74 / $20.35 / $27.06
| Professional | | $11.74 | $20.35 | $27.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.44 / $33.69 / $60.00
| Professional | | $32.44 | $33.69 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $19.55 / $23.04
| Professional | | $17.55 | $19.55 | $23.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $15.30 / $22.95
| Professional | | $13.05 | $15.30 | $22.95 |