- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.23 / $12.46 / $24.52
| Professional | | $11.23 | $12.46 | $24.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.76 / $11.76 / $19.07
| Facility | | $11.76 | $11.76 | $19.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $11.76
| Professional | | $10.30 | $10.30 | $11.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.76 / $11.76 / $19.07
| Facility | | $11.76 | $11.76 | $19.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $11.18 / $14.58
| Professional | | $10.30 | $11.18 | $14.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $10.30
| Professional | | $10.30 | $10.30 | $10.30 |