- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.60 / $13.66 / $13.98
| Facility | | $10.60 | $13.66 | $13.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.60 / $13.57 / $17.64
| Professional | | $10.60 | $13.57 | $17.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.64 / $13.64 / $17.39
| Professional | | $13.64 | $13.64 | $17.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.18 / $25.00 / $30.00
| Professional | | $9.18 | $25.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Professional | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.74 / $31.74 / $33.04
| Professional | | $31.74 | $31.74 | $33.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.00 / $21.00 / $21.00
| Professional | | $21.00 | $21.00 | $21.00 |