- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.57 / $18.21 / $28.88
| Facility | | $12.57 | $18.21 | $28.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.71 / $17.87 / $25.41
| Professional | | $10.71 | $17.87 | $25.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $19.62 / $28.06
| Professional | | $10.61 | $19.62 | $28.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.57 / $16.57 / $19.89
| Facility | | $16.57 | $16.57 | $19.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.76 / $20.01 / $33.17
| Professional | | $10.76 | $20.01 | $33.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.72 / $23.88 / $35.86
| Professional | | $16.72 | $23.88 | $35.86 |