- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.78 / $16.44 / $19.73
| Facility | | $10.78 | $16.44 | $19.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $10.65 / $10.78
| Professional | | $9.86 | $10.65 | $10.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.47 / $17.75 / $19.73
| Facility | | $14.47 | $17.75 | $19.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.78 / $15.78 / $17.75
| Professional | | $15.78 | $15.78 | $17.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.69 / $39.46 / $50.00
| Facility | | $10.69 | $39.46 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.37 / $19.10 / $63.38
| Professional | | $4.37 | $19.10 | $63.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.44 / $4.74 / $13.02
| Professional | | $3.44 | $4.74 | $13.02 |