- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.38 / $16.30 / $19.92
| Facility | | $15.38 | $16.30 | $19.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.39 / $16.23 / $19.92
| Professional | | $14.39 | $16.23 | $19.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $15.77 / $15.77
| Professional | | $15.77 | $15.77 | $15.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.53 / $12.87 / $16.55
| Professional | | $12.53 | $12.87 | $16.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.24 / $26.16 / $32.22
| Professional | | $22.24 | $26.16 | $32.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.02 / $19.39 / $32.07
| Professional | | $14.02 | $19.39 | $32.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.63 / $14.63 / $14.63
| Professional | | $14.63 | $14.63 | $14.63 |