- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.07 / $16.48 / $32.21
| Facility | | $10.07 | $16.48 | $32.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.72 / $8.72 / $10.07
| Professional | | $8.72 | $8.72 | $10.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.54 / $27.85 / $40.33
| Facility | | $20.54 | $27.85 | $40.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.75 / $12.75 / $19.57
| Professional | | $12.75 | $12.75 | $19.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.30 / $9.36 / $19.59
| Facility | | $8.30 | $9.36 | $19.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.91 / $12.19 / $19.10
| Professional | | $5.91 | $12.19 | $19.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.54 / $14.52 / $70.00
| Facility | | $11.54 | $14.52 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.64 / $6.93 / $16.76
| Professional | | $5.64 | $6.93 | $16.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.92 / $12.08 / $16.36
| Facility | | $5.92 | $12.08 | $16.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.64 / $6.71 / $10.31
| Professional | | $5.64 | $6.71 | $10.31 |