- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $19.30 / $22.91
| Professional | | $16.93 | $19.30 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.84 / $21.47 / $31.31
| Facility | | $19.84 | $21.47 | $31.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.80 / $22.53 / $26.62
| Professional | | $20.80 | $22.53 | $26.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $21.50 / $30.26
| Facility | | $18.62 | $21.50 | $30.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $21.82 / $68.53
| Professional | | $15.85 | $21.82 | $68.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.16 / $17.38 / $31.74
| Professional | | $11.16 | $17.38 | $31.74 |