- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.36 / $21.58 / $26.15
| Facility | | $8.36 | $21.58 | $26.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.37 / $13.12 / $23.71
| Professional | | $7.37 | $13.12 | $23.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $20.58 / $33.36
| Professional | | $10.27 | $20.58 | $33.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.10 / $11.10 / $11.10
| Facility | | $11.10 | $11.10 | $11.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.66 / $11.66 / $600.00
| Facility | | $11.66 | $11.66 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.83 / $20.83 / $20.83
| Professional | | $20.83 | $20.83 | $20.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.66 / $11.66 / $925.00
| Facility | | $11.66 | $11.66 | $925.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.83 / $20.83 / $20.83
| Professional | | $20.83 | $20.83 | $20.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.28 / $33.83 / $50.03
| Professional | | $21.28 | $33.83 | $50.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.03 / $24.74 / $44.40
| Professional | | $17.03 | $24.74 | $44.40 |