- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.57 / $22.85 / $96.27
| Facility | | $8.57 | $22.85 | $96.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.44 / $10.22 / $18.69
| Professional | | $8.44 | $10.22 | $18.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.86 / $2.86 / $6.86
| Professional | | $2.86 | $2.86 | $6.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.74 / $52.03 / $75.36
| Facility | | $38.74 | $52.03 | $75.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.86 / $10.86 / $11.68
| Professional | | $10.86 | $10.86 | $11.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.43 / $7.99 / $18.67
| Facility | | $7.43 | $7.99 | $18.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $11.40 / $16.52
| Professional | | $5.04 | $11.40 | $16.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.72 / $10.37 / $100.00
| Facility | | $9.72 | $10.37 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.80 / $6.59 / $14.29
| Professional | | $4.80 | $6.59 | $14.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.80 / $5.33 / $7.43
| Professional | | $4.80 | $5.33 | $7.43 |