- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.50 / $8.40 / $12.04
| Facility | | $5.50 | $8.40 | $12.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $8.84 / $67.63
| Professional | | $5.00 | $8.84 | $67.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.45 / $12.69 / $14.93
| Professional | | $10.45 | $12.69 | $14.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.44 / $17.00 / $17.51
| Professional | | $15.44 | $17.00 | $17.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.46 / $12.16 / $18.70
| Facility | | $7.46 | $12.16 | $18.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.55 / $13.52 / $19.69
| Professional | | $12.55 | $13.52 | $19.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.69 / $13.52 / $18.42
| Professional | | $12.69 | $13.52 | $18.42 |