- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.48 / $31.82 / $156.38
| Facility | | $7.48 | $31.82 | $156.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $7.63 / $9.91
| Professional | | $6.47 | $7.63 | $9.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.37 / $6.07 / $6.70
| Professional | | $4.37 | $6.07 | $6.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.88 / $17.66 / $31.92
| Facility | | $4.88 | $17.66 | $31.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $7.36 / $10.49
| Professional | | $5.05 | $7.36 | $10.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.13 / $14.20 / $25.56
| Facility | | $6.13 | $14.20 | $25.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.82 / $9.91 / $13.43
| Professional | | $5.82 | $9.91 | $13.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.56 / $7.63 / $100.00
| Facility | | $6.56 | $7.63 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.67 / $5.13 / $8.05
| Professional | | $3.67 | $5.13 | $8.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.67 / $5.13 / $8.05
| Professional | | $3.67 | $5.13 | $8.05 |