- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.36 / $10.76 / $27.24
| Facility | | $9.36 | $10.76 | $27.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $17.32 / $44.00
| Professional | | $10.06 | $17.32 | $44.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $10.74 / $17.09
| Professional | | $10.74 | $10.74 | $17.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.52 / $11.92 / $12.44
| Professional | | $7.52 | $11.92 | $12.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.63 / $25.52 / $31.90
| Facility | | $14.63 | $25.52 | $31.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.51 / $25.52 / $36.46
| Professional | | $19.51 | $25.52 | $36.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.36 / $21.36 / $21.36
| Facility | | $21.36 | $21.36 | $21.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.44 / $7.44 / $46.86
| Professional | | $7.44 | $7.44 | $46.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.70 / $45.00 / $45.00
| Professional | | $23.70 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.06 / $9.08 / $12.48
| Professional | | $6.06 | $9.08 | $12.48 |