- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.36 / $7.49 / $13.82
| Professional | | $6.36 | $7.49 | $13.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.65 / $10.65 / $13.97
| Facility | | $10.65 | $10.65 | $13.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.05 / $10.65 / $18.00
| Professional | | $9.05 | $10.65 | $18.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.66 / $14.66 / $17.98
| Professional | | $14.66 | $14.66 | $17.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $13.32 / $13.32
| Professional | | $11.06 | $13.32 | $13.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.73 / $10.30 / $16.80
| Professional | | $7.73 | $10.30 | $16.80 |