- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.57 / $18.84 / $21.08
| Professional | | $16.57 | $18.84 | $21.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.35 / $17.41 / $25.06
| Facility | | $2.35 | $17.41 | $25.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $18.75 / $24.99
| Professional | | $2.19 | $18.75 | $24.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $36.52
| Facility | | $20.72 | $20.72 | $36.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $22.61 / $27.20
| Professional | | $20.72 | $22.61 | $27.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.55 / $17.35 / $26.83
| Professional | | $12.55 | $17.35 | $26.83 |