- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.46 / $11.82 / $15.56
| Professional | | $11.46 | $11.82 | $15.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.10 / $50.09 / $59.31
| Facility | | $37.10 | $50.09 | $59.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.71 / $13.78 / $23.06
| Professional | | $11.71 | $13.78 | $23.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.34 / $13.34 / $15.17
| Facility | | $13.34 | $13.34 | $15.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.74 / $13.34 / $13.34
| Professional | | $9.74 | $13.34 | $13.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.72 / $13.09 / $21.81
| Professional | | $8.72 | $13.09 | $21.81 |