- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.16 / $17.01 / $20.42
| Facility | | $11.16 | $17.01 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $11.02 / $11.16
| Professional | | $10.21 | $11.02 | $11.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.97 / $18.37 / $20.42
| Facility | | $14.97 | $18.37 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.32 / $16.32 / $18.37
| Professional | | $16.32 | $16.32 | $18.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.06 / $40.84 / $50.00
| Facility | | $11.06 | $40.84 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $19.62 / $75.28
| Professional | | $6.48 | $19.62 | $75.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.12 / $6.98 / $21.78
| Professional | | $6.12 | $6.98 | $21.78 |