- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $27.09
| Facility | | $10.54 | $10.54 | $27.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.04 / $13.42 / $13.65
| Professional | | $12.04 | $13.42 | $13.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.66 / $30.33 / $33.86
| Professional | | $22.66 | $30.33 | $33.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $17.52 / $22.03
| Professional | | $17.35 | $17.52 | $22.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $22.58 / $80.00
| Facility | | $10.54 | $22.58 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $16.52 / $25.81
| Professional | | $9.02 | $16.52 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $16.52 / $25.81
| Professional | | $9.02 | $16.52 | $25.81 |