- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.70 / $10.70 / $27.52
| Facility | | $10.70 | $10.70 | $27.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.65 / $11.10 / $14.37
| Professional | | $7.65 | $11.10 | $14.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.02 / $30.81 / $34.40
| Professional | | $23.02 | $30.81 | $34.40 |
- 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
- $10.70 / $18.53 / $80.00
| Facility | | $10.70 | $18.53 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.42 / $16.76 / $25.99
| Professional | | $6.42 | $16.76 | $25.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.42 / $8.38 / $21.41
| Professional | | $6.42 | $8.38 | $21.41 |