- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $17.82 / $25.10
| Facility | | $12.59 | $17.82 | $25.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.53 / $17.36 / $24.42
| Professional | | $10.53 | $17.36 | $24.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.35 / $16.46 / $32.51
| Professional | | $12.35 | $16.46 | $32.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.48 / $20.48 / $20.48
| Facility | | $20.48 | $20.48 | $20.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $20.01 / $32.29
| Professional | | $12.28 | $20.01 | $32.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.25 / $24.34 / $33.58
| Professional | | $19.25 | $24.34 | $33.58 |