- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.39 / $18.75 / $26.58
| Facility | | $10.39 | $18.75 | $26.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.36 / $7.42 / $26.04
| Professional | | $6.36 | $7.42 | $26.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.15 / $17.63 / $22.03
| Professional | | $11.15 | $17.63 | $22.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.63 / $12.52 / $87.15
| Professional | | $9.63 | $12.52 | $87.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $12.47 / $26.60
| Facility | | $8.32 | $12.47 | $26.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $9.63 / $24.00
| Professional | | $4.07 | $9.63 | $24.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.79 / $16.16 / $24.62
| Facility | | $11.79 | $16.16 | $24.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.56 / $17.63 / $25.13
| Professional | | $11.56 | $17.63 | $25.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $5.78 / $19.80
| Professional | | $4.07 | $5.78 | $19.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.61 / $9.63 / $9.63
| Professional | | $7.61 | $9.63 | $9.63 |