- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $17.78 / $25.12
| Facility | | $12.02 | $17.78 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $16.98 / $25.12
| Professional | | $10.00 | $16.98 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $24.55 / $32.36
| Professional | | $21.88 | $24.55 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $20.42
| Facility | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $20.42 / $33.11
| Professional | | $11.75 | $20.42 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $19.05 / $29.51
| Professional | | $12.02 | $19.05 | $29.51 |