- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.47 / $21.22 / $52.70
| Facility | | $11.47 | $21.22 | $52.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.17 / $12.08 / $18.01
| Professional | | $10.17 | $12.08 | $18.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.41 / $16.73 / $20.54
| Professional | | $8.41 | $16.73 | $20.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.14 / $32.86 / $58.70
| Facility | | $10.14 | $32.86 | $58.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.01 / $9.89 / $22.77
| Professional | | $7.01 | $9.89 | $22.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.63 / $80.00 / $80.00
| Facility | | $72.63 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.17 / $15.29 / $21.03
| Professional | | $9.17 | $15.29 | $21.03 |